- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.07 / $226.07 / $581.33
| Facility | | $226.07 | $226.07 | $581.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.07 / $226.07 / $303.58
| Professional | | $226.07 | $226.07 | $303.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.90 / $650.76 / $730.29
| Professional | | $536.90 | $650.76 | $730.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.87 / $374.58 / $471.01
| Professional | | $370.87 | $374.58 | $471.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.07 / $433.21 / $1,534.06
| Facility | | $226.07 | $433.21 | $1,534.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.38 / $387.55 / $553.78
| Professional | | $155.38 | $387.55 | $553.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.63 / $225.94 / $553.78
| Professional | | $135.63 | $225.94 | $553.78 |