- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $453.26 / $529.66 / $812.53
| Facility | | $453.26 | $529.66 | $812.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.01 / $490.18 / $575.23
| Professional | | $320.01 | $490.18 | $575.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $849.56 / $849.56 / $849.56
| Professional | | $849.56 | $849.56 | $849.56 |
- 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
- $602.40 / $602.40 / $602.40
| Facility | | $602.40 | $602.40 | $602.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $523.45 / $849.56 / $849.56
| Professional | | $523.45 | $849.56 | $849.56 |