- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.91 / $476.40 / $873.10
| Facility | | $223.91 | $476.40 | $873.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.74 / $317.60 / $317.60
| Professional | | $207.74 | $317.60 | $317.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.76 / $116.76 / $116.76
| Professional | | $116.76 | $116.76 | $116.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $317.60 / $327.13 / $406.53
| Facility | | $317.60 | $327.13 | $406.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $55.00 / $3,500.00
| Professional | | $30.00 | $55.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $359.36 / $490.68 / $631.02
| Facility | | $359.36 | $490.68 | $631.02 |