- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $354.81 / $1,023.29
| Facility | | $263.03 | $354.81 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $338.84 / $602.56
| Professional | | $263.03 | $338.84 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $371.54 / $1,412.54
| Facility | | $275.42 | $371.54 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $426.58 / $794.33
| Professional | | $331.13 | $426.58 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $380.19 / $2,344.23
| Facility | | $380.19 | $380.19 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $275.42 / $870.96
| Professional | | $275.42 | $275.42 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $457.09 / $812.83
| Facility | | $295.12 | $457.09 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $338.84 / $501.19
| Professional | | $234.42 | $338.84 | $501.19 |