- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $602.56 / $1,318.26
| Facility | | $245.47 | $602.56 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $275.42 / $338.84
| Professional | | $208.93 | $275.42 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $912.01
| Facility | | $346.74 | $346.74 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $346.74
| Facility | | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $346.74 / $346.74
| Professional | | $257.04 | $346.74 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $691.83 / $50,118.72
| Facility | | $457.09 | $691.83 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $512.86
| Professional | | $346.74 | $346.74 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $660.69 / $50,118.72
| Facility | | $457.09 | $660.69 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $363.08
| Professional | | $346.74 | $346.74 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $208.93 / $524.81
| Professional | | $147.91 | $208.93 | $524.81 |