- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.52 / $234.52 / $234.52
| Facility | | $234.52 | $234.52 | $234.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.07 / $234.52 / $281.42
| Professional | | $178.07 | $234.52 | $281.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $326.57 / $374.33 / $1,552.02
| Facility | | $326.57 | $374.33 | $1,552.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.06 / $326.57 / $368.27
| Professional | | $174.06 | $326.57 | $368.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.10 / $346.10 / $346.10
| Facility | | $346.10 | $346.10 | $346.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $256.50 / $365.00 / $386.04
| Facility | | $256.50 | $365.00 | $386.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.03 / $256.50 / $679.69
| Professional | | $218.03 | $256.50 | $679.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.62 / $313.62 / $313.62
| Professional | | $313.62 | $313.62 | $313.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $1,552.02 / $1,552.02
| Facility | | $100.00 | $1,552.02 | $1,552.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.41 / $218.18 / $372.72
| Professional | | $171.41 | $218.18 | $372.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.41 / $252.74 / $388.67
| Professional | | $171.41 | $252.74 | $388.67 |