- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $266.98 / $453.54 / $33,112.55
| Facility | | $266.98 | $453.54 | $33,112.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.98 / $266.98 / $266.98
| Professional | | $266.98 | $266.98 | $266.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $259.63 / $295.22 / $339.50
| Facility | | $259.63 | $295.22 | $339.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.15 / $230.15 / $230.15
| Professional | | $230.15 | $230.15 | $230.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.15 / $230.15 / $581.53
| Facility | | $230.15 | $230.15 | $581.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.15 / $230.15 / $230.15
| Professional | | $230.15 | $230.15 | $230.15 |