- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.19 / $471.19 / $471.19
| Professional | | $471.19 | $471.19 | $471.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.62 / $487.54 / $513.20
| Professional | | $451.62 | $487.54 | $513.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.85 / $382.81 / $382.81
| Facility | | $324.85 | $382.81 | $382.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.27 / $382.81 / $669.22
| Professional | | $326.27 | $382.81 | $669.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.04 / $471.19 / $1,770.01
| Facility | | $46.04 | $471.19 | $1,770.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.22 / $217.61 / $382.91
| Professional | | $131.22 | $217.61 | $382.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $69.15 / $69.65 / $131.54
| Facility | | $69.15 | $69.65 | $131.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.65 / $86.01 / $164.63
| Professional | | $69.65 | $86.01 | $164.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.22 / $216.54 / $377.46
| Professional | | $131.22 | $216.54 | $377.46 |