- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $334.32 / $390.67 / $599.29
| Facility | | $334.32 | $390.67 | $599.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.03 / $360.26 / $424.28
| Professional | | $236.03 | $360.26 | $424.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.71 / $626.71 / $626.71
| Professional | | $626.71 | $626.71 | $626.71 |
- 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
- $472.22 / $472.22 / $472.22
| Facility | | $472.22 | $472.22 | $472.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.75 / $626.71 / $626.71
| Professional | | $373.75 | $626.71 | $626.71 |