- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $391.77 / $391.77 / $391.77
| Facility | | $391.77 | $391.77 | $391.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.75 / $387.61 / $391.77
| Professional | | $291.75 | $387.61 | $391.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.94 / $416.78 / $416.78
| Facility | | $395.94 | $416.78 | $416.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.42 / $416.78 / $416.78
| Professional | | $333.42 | $416.78 | $416.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $974.23 / $1,520.52 / $3,657.81
| Facility | | $974.23 | $1,520.52 | $3,657.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.45 / $607.91 / $843.42
| Professional | | $483.45 | $607.91 | $843.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $844.25 / $1,390.12 / $2,880.16
| Facility | | $844.25 | $1,390.12 | $2,880.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.67 / $478.67 / $756.60
| Professional | | $478.67 | $478.67 | $756.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.78 / $750.20 / $1,262.83
| Facility | | $416.78 | $750.20 | $1,262.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.56 / $333.42 / $1,098.97
| Professional | | $212.56 | $333.42 | $1,098.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.39 / $333.42 / $903.58
| Professional | | $208.39 | $333.42 | $903.58 |