- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $420.82 / $443.71 / $1,151.72
| Professional | | $420.82 | $443.71 | $1,151.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.80 / $8.01 / $8.01
| Professional | | $6.80 | $8.01 | $8.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $420.82 / $443.71 / $1,750.61
| Facility | | $420.82 | $443.71 | $1,750.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $420.82 / $1,750.61 / $2,020.13
| Facility | | $420.82 | $1,750.61 | $2,020.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $65.00 / $70.00
| Professional | | $50.00 | $65.00 | $70.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $420.82 / $443.71 / $1,750.61
| Facility | | $420.82 | $443.71 | $1,750.61 |