- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.92 / $344.90 / $1,991.19
| Facility | | $275.92 | $344.90 | $1,991.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.92 / $298.91 / $331.10
| Professional | | $275.92 | $298.91 | $331.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.99 / $317.77 / $1,729.04
| Facility | | $226.99 | $317.77 | $1,729.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528.64 / $560.44 / $700.55
| Professional | | $528.64 | $560.44 | $700.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.18 / $275.92 / $544.89
| Professional | | $261.18 | $275.92 | $544.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.94 / $193.14 / $473.66
| Professional | | $160.94 | $193.14 | $473.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.21 / $275.92 / $275.92
| Professional | | $238.21 | $275.92 | $275.92 |