- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $602.56 / $1,047.13
| Facility | | $354.81 | $602.56 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $354.81 / $562.34
| Professional | | $323.59 | $354.81 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $436.52 / $457.09
| Facility | | $363.08 | $436.52 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $97.72 / $109.65
| Professional | | $97.72 | $97.72 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $602.56 / $831.76
| Facility | | $436.52 | $602.56 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $562.34 / $724.44
| Professional | | $467.74 | $562.34 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $691.83 / $691.83
| Facility | | $281.84 | $691.83 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $2,089.30 / $2,089.30
| Professional | | $199.53 | $2,089.30 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $263.03 / $263.03
| Facility | | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $263.03 / $436.52
| Professional | | $181.97 | $263.03 | $436.52 |