- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.11 / $294.44 / $1,371.83
| Facility | | $263.11 | $294.44 | $1,371.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.08 / $294.44 / $416.68
| Professional | | $246.08 | $294.44 | $416.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $286.48 / $337.03 / $361.46
| Facility | | $286.48 | $337.03 | $361.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.60 / $283.72 / $283.72
| Professional | | $259.60 | $283.72 | $283.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.44 / $303.10 / $594.08
| Facility | | $294.44 | $303.10 | $594.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.87 / $323.87 / $323.87
| Facility | | $323.87 | $323.87 | $323.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.87 / $323.87 / $323.87
| Professional | | $323.87 | $323.87 | $323.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.07 / $136.10 / $174.92
| Professional | | $1.07 | $136.10 | $174.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.17 / $346.40 / $361.46
| Professional | | $289.17 | $346.40 | $361.46 |