- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.76 / $549.62 / $602.67
| Facility | | $426.76 | $549.62 | $602.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.10 / $540.02 / $646.61
| Professional | | $343.10 | $540.02 | $646.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.40 / $675.40 / $675.40
| Professional | | $675.40 | $675.40 | $675.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.00 / $273.19 / $766.44
| Professional | | $250.00 | $273.19 | $766.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $50.00 / $50.00
| Professional | | $50.00 | $50.00 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $708.00 / $708.00 / $708.00
| Professional | | $708.00 | $708.00 | $708.00 |