- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $317.42 / $412.65 / $691.66
| Facility | | $317.42 | $412.65 | $691.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.42 / $318.52 / $382.24
| Professional | | $317.42 | $318.52 | $382.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.35 / $332.39 / $380.30
| Professional | | $311.35 | $332.39 | $380.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.36 / $318.52 / $318.52
| Facility | | $311.36 | $318.52 | $318.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.52 / $318.52 / $318.52
| Professional | | $318.52 | $318.52 | $318.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.34 / $424.48 / $1,592.65
| Facility | | $416.34 | $424.48 | $1,592.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,374.70 / $1,374.70 / $1,374.70
| Professional | | $1,374.70 | $1,374.70 | $1,374.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $516.45 / $516.45 / $516.45
| Facility | | $516.45 | $516.45 | $516.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.12 / $318.52 / $355.47
| Professional | | $312.12 | $318.52 | $355.47 |