- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $304.81 / $304.81 / $762.03
| Facility | | $304.81 | $304.81 | $762.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.90 / $246.90 / $304.81
| Professional | | $246.90 | $246.90 | $304.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.95 / $448.07 / $2,442.71
| Facility | | $294.95 | $448.07 | $2,442.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.92 / $121.92 / $308.13
| Professional | | $121.92 | $121.92 | $308.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.16 / $650.16 / $650.16
| Facility | | $650.16 | $650.16 | $650.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.17 / $308.36 / $322.20
| Professional | | $193.17 | $308.36 | $322.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.81 / $304.81 / $307.86
| Professional | | $304.81 | $304.81 | $307.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $304.81 / $304.81 / $762.03
| Facility | | $304.81 | $304.81 | $762.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.90 / $304.81 / $304.81
| Professional | | $246.90 | $304.81 | $304.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.44 / $182.89 / $457.22
| Professional | | $155.44 | $182.89 | $457.22 |