- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.33 / $306.87 / $4,364.82
| Facility | | $302.33 | $306.87 | $4,364.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.16 / $157.27 / $541.29
| Professional | | $151.16 | $157.27 | $541.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $127.68 / $301.64 / $745.97
| Facility | | $127.68 | $301.64 | $745.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.68 / $159.60 / $377.06
| Professional | | $129.68 | $159.60 | $377.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.16 / $151.16 / $151.16
| Facility | | $151.16 | $151.16 | $151.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.16 / $151.16 / $151.16
| Professional | | $151.16 | $151.16 | $151.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.33 / $181.91 / $340.68
| Facility | | $150.33 | $181.91 | $340.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.33 / $150.33 / $326.22
| Professional | | $150.33 | $150.33 | $326.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.16 / $151.16 / $151.16
| Professional | | $151.16 | $151.16 | $151.16 |