- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.54 / $593.54 / $868.61
| Facility | | $593.54 | $593.54 | $868.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.07 / $615.26 / $868.61
| Professional | | $579.07 | $615.26 | $868.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $615.26 / $615.26 / $615.26
| Facility | | $615.26 | $615.26 | $615.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $615.26 / $615.26 / $615.26
| Professional | | $615.26 | $615.26 | $615.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.00 / $25.00 / $50.00
| Professional | | $17.00 | $25.00 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.65 / $723.84 / $940.99
| Professional | | $687.65 | $723.84 | $940.99 |