- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.26 / $460.30 / $690.45
| Facility | | $246.26 | $460.30 | $690.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.46 / $253.29 / $495.15
| Professional | | $232.46 | $253.29 | $495.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.14 / $790.57 / $1,270.19
| Facility | | $194.14 | $790.57 | $1,270.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.30 / $215.71 / $1,464.03
| Professional | | $148.30 | $215.71 | $1,464.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $217.13 / $230.15 / $230.15
| Facility | | $217.13 | $230.15 | $230.15 |
- 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
- $202.63 / $296.42 / $362.20
| Facility | | $202.63 | $296.42 | $362.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.26 / $230.26 / $230.26
| Professional | | $230.26 | $230.26 | $230.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.15 / $230.15 / $230.15
| Professional | | $230.15 | $230.15 | $230.15 |