- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $331.13 / $741.31
| Facility | | $263.03 | $331.13 | $741.31 |
- 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
- $354.81 / $416.87 / $758.58
| Professional | | $354.81 | $416.87 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $389.05 / $2,454.71
| Facility | | $389.05 | $389.05 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $281.84 / $870.96
| Professional | | $281.84 | $281.84 | $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 |