- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $286.31 / $473.24 / $709.86
| Facility | | $286.31 | $473.24 | $709.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.62 / $238.98 / $312.33
| Professional | | $236.62 | $238.98 | $312.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $203.10 / $744.64 / $1,265.54
| Facility | | $203.10 | $744.64 | $1,265.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.15 / $229.05 / $251.95
| Professional | | $227.15 | $229.05 | $251.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.22 / $236.62 / $236.62
| Facility | | $223.22 | $236.62 | $236.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.62 / $236.62 / $236.62
| Professional | | $236.62 | $236.62 | $236.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $236.62 / $272.11 / $472.37
| Facility | | $236.62 | $272.11 | $472.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.62 / $236.62 / $513.47
| Professional | | $236.62 | $236.62 | $513.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.62 / $236.62 / $250.82
| Professional | | $236.62 | $236.62 | $250.82 |