- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $436.52 / $19,952.62
| Facility | | $245.47 | $436.52 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $346.74
| Professional | | $245.47 | $245.47 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $323.59 / $676.08
| Facility | | $263.03 | $323.59 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $338.84
| Professional | | $245.47 | $245.47 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $245.47 / $363.08
| Facility | | $234.42 | $245.47 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $288.40
| Professional | | $245.47 | $245.47 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $245.47 / $426.58
| Facility | | $239.88 | $245.47 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $245.47 / $281.84
| Professional | | $239.88 | $245.47 | $281.84 |