- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $276.56 / $404.96 / $519.91
| Facility | | $276.56 | $404.96 | $519.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.48 / $973.03 / $1,545.93
| Facility | | $612.48 | $973.03 | $1,545.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.97 / $315.27 / $1,446.69
| Facility | | $269.97 | $315.27 | $1,446.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.20 / $423.74 / $2,343.00
| Professional | | $313.20 | $423.74 | $2,343.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.77 / $423.74 / $559.89
| Professional | | $294.77 | $423.74 | $559.89 |