- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.11 / $298.95 / $308.52
| Facility | | $202.11 | $298.95 | $308.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.11 / $231.59 / $421.07
| Professional | | $202.11 | $231.59 | $421.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.39 / $464.51 / $2,042.07
| Facility | | $442.39 | $464.51 | $2,042.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.82 / $267.12 / $358.07
| Professional | | $225.82 | $267.12 | $358.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $286.80 / $286.80 / $286.80
| Facility | | $286.80 | $286.80 | $286.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.36 / $209.36 / $209.36
| Professional | | $209.36 | $209.36 | $209.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.11 / $370.54 / $2,070.19
| Facility | | $202.11 | $370.54 | $2,070.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.11 / $236.47 / $357.55
| Professional | | $165.11 | $236.47 | $357.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.11 / $220.70 / $327.17
| Professional | | $165.11 | $220.70 | $327.17 |