- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.08 / $241.66 / $977.52
| Facility | | $202.08 | $241.66 | $977.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.17 / $232.46 / $241.66
| Professional | | $208.17 | $232.46 | $241.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.05 / $245.01 / $421.75
| Facility | | $132.05 | $245.01 | $421.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.22 / $268.32 / $314.74
| Professional | | $217.22 | $268.32 | $314.74 |
- 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
- $175.43 / $265.83 / $567.74
| Facility | | $175.43 | $265.83 | $567.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.81 / $347.81 / $347.81
| Professional | | $347.81 | $347.81 | $347.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.15 / $230.15 / $253.17
| Professional | | $230.15 | $230.15 | $253.17 |