- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.08 / $658.10 / $987.15
| Facility | | $352.08 | $658.10 | $987.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.96 / $362.01 / $434.41
| Professional | | $361.96 | $362.01 | $434.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.24 / $845.66 / $1,640.31
| Facility | | $263.24 | $845.66 | $1,640.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.20 / $308.64 / $2,093.15
| Professional | | $212.20 | $308.64 | $2,093.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.43 / $329.05 / $329.05
| Facility | | $310.43 | $329.05 | $329.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.05 / $329.05 / $329.05
| Professional | | $329.05 | $329.05 | $329.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.37 / $424.13 / $517.66
| Facility | | $324.37 | $424.13 | $517.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.10 / $329.10 / $329.10
| Professional | | $329.10 | $329.10 | $329.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.05 / $329.05 / $329.05
| Professional | | $329.05 | $329.05 | $329.05 |