- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $1,047.13 / $1,621.81
| Facility | | $316.23 | $1,047.13 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $316.23 / $436.52
| Professional | | $316.23 | $316.23 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $64.57 / $64.57
| Facility | | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $52.48 / $52.48
| Professional | | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $977.24 / $1,737.80
| Facility | | $467.74 | $977.24 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $933.25 / $1,621.81
| Facility | | $316.23 | $933.25 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $316.23 / $446.68
| Professional | | $316.23 | $316.23 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.60 / $0.60 / $0.60
| Professional | | $0.60 | $0.60 | $0.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $977.24 / $1,230.27
| Facility | | $524.81 | $977.24 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $436.52
| Professional | | $436.52 | $436.52 | $436.52 |