- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.71 / $578.11 / $932.48
| Facility | | $494.71 | $578.11 | $932.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.52 / $214.23 / $257.33
| Professional | | $188.52 | $214.23 | $257.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $50.00 / $70.00
| Professional | | $50.00 | $50.00 | $70.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $541.86 / $541.86 / $541.86
| Facility | | $541.86 | $541.86 | $541.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.49 / $434.51 / $1,233.51
| Professional | | $298.49 | $434.51 | $1,233.51 |