- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.10 / $286.42 / $439.38
| Facility | | $245.10 | $286.42 | $439.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.05 / $263.60 / $311.06
| Professional | | $173.05 | $263.60 | $311.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.00 / $500.00 / $500.00
| Professional | | $500.00 | $500.00 | $500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $58.40 / $70.00
| Professional | | $50.00 | $58.40 | $70.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $600.00 / $600.00 / $600.00
| Facility | | $600.00 | $600.00 | $600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.44 / $500.00 / $500.00
| Professional | | $224.44 | $500.00 | $500.00 |