- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.31 / $330.31 / $502.88
| Facility | | $330.31 | $330.31 | $502.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.36 / $461.36 / $507.49
| Professional | | $461.36 | $461.36 | $507.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.42 / $316.42 / $396.37
| Professional | | $316.42 | $316.42 | $396.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $461.36 / $461.36 / $461.36
| Facility | | $461.36 | $461.36 | $461.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.36 / $461.36 / $461.36
| Professional | | $461.36 | $461.36 | $461.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.61 / $500.53 / $1,668.00
| Professional | | $179.61 | $500.53 | $1,668.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.38 / $127.38 / $127.38
| Professional | | $127.38 | $127.38 | $127.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.36 / $461.36 / $461.36
| Professional | | $461.36 | $461.36 | $461.36 |