- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.99 / $348.26 / $1,700.00
| Facility | | $225.99 | $348.26 | $1,700.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.62 / $231.91 / $346.08
| Professional | | $200.62 | $231.91 | $346.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.75 / $269.70 / $293.83
| Facility | | $239.75 | $269.70 | $293.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.02 / $261.19 / $261.19
| Professional | | $134.02 | $261.19 | $261.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $256.99 / $256.99 / $256.99
| Facility | | $256.99 | $256.99 | $256.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.00 / $340.17 / $665.04
| Professional | | $218.00 | $340.17 | $665.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.45 / $268.98 / $403.23
| Professional | | $184.45 | $268.98 | $403.23 |