- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.52 / $985.07 / $1,031.42
| Facility | | $718.52 | $985.07 | $1,031.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $718.52 / $803.66 / $1,031.42
| Professional | | $718.52 | $803.66 | $1,031.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.46 / $218.46 / $240.31
| Facility | | $218.46 | $218.46 | $240.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.16 / $135.16 / $135.16
| Professional | | $135.16 | $135.16 | $135.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.76 / $750.60 / $750.60
| Professional | | $71.76 | $750.60 | $750.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.57 / $62.77 / $230.68
| Professional | | $40.57 | $62.77 | $230.68 |