- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.52 / $294.52 / $1,316.50
| Facility | | $294.52 | $294.52 | $1,316.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.56 / $238.56 / $294.52
| Professional | | $238.56 | $238.56 | $294.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.01 / $432.94 / $1,723.66
| Facility | | $285.01 | $432.94 | $1,723.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.81 / $117.81 / $380.75
| Professional | | $117.81 | $117.81 | $380.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $628.21 / $628.21 / $628.21
| Facility | | $628.21 | $628.21 | $628.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.34 / $298.20 / $311.23
| Professional | | $207.34 | $298.20 | $311.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.52 / $294.52 / $297.47
| Professional | | $294.52 | $294.52 | $297.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.52 / $294.52 / $1,316.50
| Facility | | $294.52 | $294.52 | $1,316.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.56 / $294.52 / $294.52
| Professional | | $238.56 | $294.52 | $294.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.71 / $401.19 / $581.73
| Professional | | $176.71 | $401.19 | $581.73 |