- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.07 / $226.07 / $581.33
| Facility | | $226.07 | $226.07 | $581.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.07 / $303.58 / $303.58
| Professional | | $226.07 | $303.58 | $303.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.14 / $650.76 / $726.66
| Professional | | $486.14 | $650.76 | $726.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.87 / $370.87 / $544.46
| Professional | | $370.87 | $370.87 | $544.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.78 / $245.45 / $581.33
| Facility | | $193.78 | $245.45 | $581.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.01 / $426.15 / $645.91
| Professional | | $183.01 | $426.15 | $645.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.63 / $329.42 / $549.03
| Professional | | $135.63 | $329.42 | $549.03 |