- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $273.98 / $427.61 / $1,028.67
| Facility | | $273.98 | $427.61 | $1,028.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.50 / $230.74 / $396.10
| Professional | | $183.50 | $230.74 | $396.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219.88 / $377.01 / $809.98
| Facility | | $219.88 | $377.01 | $809.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.69 / $215.05 / $366.77
| Professional | | $181.69 | $215.05 | $366.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $535.10 / $535.10 / $535.10
| Facility | | $535.10 | $535.10 | $535.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.27 / $549.27 / $549.27
| Professional | | $549.27 | $549.27 | $549.27 |