- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $2,187.76 / $2,187.76
| Facility | | $234.42 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $234.42 / $2,238.72
| Professional | | $204.17 | $234.42 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $295.12 / $309.03
| Facility | | $204.17 | $295.12 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $204.17 / $263.03
| Professional | | $199.53 | $204.17 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $165.96 / $263.03
| Professional | | $33.11 | $165.96 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $407.38 / $776.25
| Facility | | $323.59 | $407.38 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $223.87 / $245.47
| Professional | | $204.17 | $223.87 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $213.80
| Professional | | $204.17 | $204.17 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $204.17 / $245.47
| Professional | | $186.21 | $204.17 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.21 / $0.21 / $102.33
| Facility | | $0.21 | $0.21 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $204.17 / $204.17
| Professional | | $154.88 | $204.17 | $204.17 |