- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $384.47 / $384.47 / $384.47
| Facility | | $384.47 | $384.47 | $384.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.58 / $326.80 / $384.47
| Professional | | $307.58 | $326.80 | $384.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.39 / $326.80 / $400.50
| Professional | | $320.39 | $326.80 | $400.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $384.47 / $539.29 / $692.04
| Facility | | $384.47 | $539.29 | $692.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.39 / $320.39 / $1,460.99
| Professional | | $320.39 | $320.39 | $1,460.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.32 / $594.32 / $594.32
| Facility | | $594.32 | $594.32 | $594.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.74 / $384.74 / $384.74
| Professional | | $384.74 | $384.74 | $384.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.77 / $326.77 / $326.77
| Professional | | $326.77 | $326.77 | $326.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.39 / $320.39 / $365.25
| Professional | | $320.39 | $320.39 | $365.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.36 / $320.36 / $320.36
| Professional | | $320.36 | $320.36 | $320.36 |