- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $724.44
| Facility | | $575.44 | $575.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $169.82 / $457.09
| Professional | | $77.62 | $169.82 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $177.83 / $416.87
| Professional | | $85.11 | $177.83 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $125.89 / $125.89
| Facility | | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | 52 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $173.78 / $371.54
| Professional | | $87.10 | $173.78 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $194.98 / $426.58
| Professional | | $83.18 | $194.98 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $724.44
| Facility | | $575.44 | $575.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $204.17 / $524.81
| Professional | | $87.10 | $204.17 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $177.83 / $331.13
| Professional | | $81.28 | $177.83 | $331.13 |