- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.45 / $432.30 / $554.26
| Facility | | $238.45 | $432.30 | $554.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.72 / $360.83 / $727.49
| Professional | | $283.72 | $360.83 | $727.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.68 / $1,038.83 / $1,606.63
| Facility | | $263.68 | $1,038.83 | $1,606.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.22 / $269.41 / $1,990.42
| Professional | | $185.22 | $269.41 | $1,990.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.55 / $307.55 / $307.55
| Facility | | $307.55 | $307.55 | $307.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.55 / $307.55 / $307.55
| Professional | | $307.55 | $307.55 | $307.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $304.97 / $338.50 / $752.00
| Facility | | $304.97 | $338.50 | $752.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.30 / $329.52 / $334.54
| Professional | | $310.30 | $329.52 | $334.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.30 / $329.52 / $334.54
| Professional | | $310.30 | $329.52 | $334.54 |