- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.30 / $307.30 / $409.40
| Facility | | $307.30 | $307.30 | $409.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.30 / $318.47 / $486.09
| Professional | | $307.30 | $318.47 | $486.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.01 / $616.36 / $2,709.64
| Facility | | $587.01 | $616.36 | $2,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.45 / $346.43 / $474.91
| Professional | | $326.45 | $346.43 | $474.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $477.88 / $477.88 / $477.88
| Facility | | $477.88 | $477.88 | $477.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.85 / $348.85 / $405.49
| Professional | | $348.85 | $348.85 | $405.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.30 / $475.13 / $3,084.21
| Facility | | $307.30 | $475.13 | $3,084.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.10 / $292.85 / $713.50
| Professional | | $235.10 | $292.85 | $713.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.49 / $292.85 / $548.40
| Professional | | $223.49 | $292.85 | $548.40 |