- 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 / $226.07 / $303.58
| Professional | | $226.07 | $226.07 | $303.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.90 / $650.76 / $730.29
| Professional | | $536.90 | $650.76 | $730.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.87 / $374.58 / $471.01
| Professional | | $370.87 | $374.58 | $471.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.07 / $384.32 / $1,534.06
| Facility | | $226.07 | $384.32 | $1,534.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.63 / $358.85 / $549.03
| Professional | | $135.63 | $358.85 | $549.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.63 / $387.55 / $452.14
| Professional | | $135.63 | $387.55 | $452.14 |