- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.54 / $285.54 / $2,330.01
| Facility | | $285.54 | $285.54 | $2,330.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.54 / $285.54 / $285.54
| Professional | | $285.54 | $285.54 | $285.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.58 / $304.58 / $304.58
| Professional | | $304.58 | $304.58 | $304.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $618.67 / $643.41 / $1,384.39
| Facility | | $618.67 | $643.41 | $1,384.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.37 / $437.37 / $546.71
| Professional | | $437.37 | $437.37 | $546.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $773.89 / $773.89 / $773.89
| Professional | | $773.89 | $773.89 | $773.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.90 / $256.38 / $346.45
| Professional | | $159.90 | $256.38 | $346.45 |