- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $317.60 / $680.55 / $1,221.92
| Facility | | $317.60 | $680.55 | $1,221.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.49 / $317.60 / $348.21
| Professional | | $203.49 | $317.60 | $348.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $60.00 / $83.31
| Professional | | $60.00 | $60.00 | $83.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.18 / $180.18 / $351.35
| Professional | | $180.18 | $180.18 | $351.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.32 / $230.32 / $230.32
| Facility | | $230.32 | $230.32 | $230.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.76 / $116.76 / $116.76
| Professional | | $116.76 | $116.76 | $116.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $317.60 / $348.21 / $553.65
| Facility | | $317.60 | $348.21 | $553.65 |