- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $404.52 / $404.52 / $1,011.30
| Facility | | $404.52 | $404.52 | $1,011.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.66 / $327.66 / $404.52
| Professional | | $327.66 | $327.66 | $404.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $391.45 / $594.64 / $1,639.15
| Facility | | $391.45 | $594.64 | $1,639.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.81 / $161.81 / $311.16
| Professional | | $161.81 | $161.81 | $311.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $862.84 / $862.84 / $862.84
| Facility | | $862.84 | $862.84 | $862.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.26 / $409.51 / $427.53
| Professional | | $256.26 | $409.51 | $427.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.52 / $404.52 / $408.57
| Professional | | $404.52 | $404.52 | $408.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $404.52 / $404.52 / $1,011.30
| Facility | | $404.52 | $404.52 | $1,011.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.66 / $404.52 / $404.52
| Professional | | $327.66 | $404.52 | $404.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.72 / $242.71 / $491.81
| Professional | | $196.72 | $242.71 | $491.81 |