- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.60 / $737.62 / $2,198.23
| Facility | | $320.60 | $737.62 | $2,198.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.52 / $318.52 / $350.38
| Professional | | $318.52 | $318.52 | $350.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $318.52 / $637.05 / $770.84
| Facility | | $318.52 | $637.05 | $770.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.52 / $318.52 / $439.57
| Professional | | $318.52 | $318.52 | $439.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $318.52 / $318.52 / $477.80
| Facility | | $318.52 | $318.52 | $477.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.52 / $318.52 / $398.16
| Professional | | $318.52 | $318.52 | $398.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $318.52 / $318.52 / $318.52
| Facility | | $318.52 | $318.52 | $318.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.52 / $318.52 / $360.60
| Professional | | $318.52 | $318.52 | $360.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.52 / $337.64 / $374.18
| Professional | | $318.52 | $337.64 | $374.18 |