- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $647.62 / $794.72 / $882.56
| Professional | | $647.62 | $794.72 | $882.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $880.00 / $1,100.00 / $1,386.81
| Professional | | $880.00 | $1,100.00 | $1,386.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.00 / $200.00 / $320.06
| Facility | | $200.00 | $200.00 | $320.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.81 / $200.00 / $200.00
| Professional | | $98.81 | $200.00 | $200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $394.07 / $794.72 / $985.45
| Facility | | $394.07 | $794.72 | $985.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $800.00 / $800.00 / $800.00
| Professional | | $800.00 | $800.00 | $800.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.35 / $515.12 / $706.85
| Professional | | $366.35 | $515.12 | $706.85 |