- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.22 / $310.37 / $19,769.62
| Facility | | $310.22 | $310.37 | $19,769.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.64 / $271.57 / $310.37
| Professional | | $258.64 | $271.57 | $310.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $280.45 / $280.45 / $280.45
| Facility | | $280.45 | $280.45 | $280.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.32 / $280.45 / $280.45
| Professional | | $258.32 | $280.45 | $280.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.93 / $248.93 / $258.64
| Facility | | $188.93 | $248.93 | $258.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.64 / $258.64 / $280.60
| Professional | | $258.64 | $258.64 | $280.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.58 / $258.64 / $297.44
| Professional | | $258.58 | $258.64 | $297.44 |