- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.82 / $316.82 / $488.57
| Facility | | $316.82 | $316.82 | $488.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.85 / $306.83 / $316.82
| Professional | | $251.85 | $306.83 | $316.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $542.36 / $652.11 / $717.36
| Professional | | $542.36 | $652.11 | $717.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.37 / $534.23 / $701.53
| Professional | | $313.37 | $534.23 | $701.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.82 / $407.15 / $698.32
| Facility | | $316.82 | $407.15 | $698.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.31 / $633.64 / $1,920.89
| Professional | | $318.31 | $633.64 | $1,920.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.53 / $601.02 / $722.18
| Professional | | $345.53 | $601.02 | $722.18 |