- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $328.34 / $607.42 / $2,505.32
| Facility | | $328.34 | $607.42 | $2,505.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.92 / $328.34 / $521.03
| Professional | | $302.92 | $328.34 | $521.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.75 / $328.34 / $578.92
| Facility | | $309.75 | $328.34 | $578.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.34 / $328.34 / $328.34
| Professional | | $328.34 | $328.34 | $328.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.49 / $328.34 / $328.34
| Facility | | $14.49 | $328.34 | $328.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.46 / $346.92 / $346.92
| Professional | | $173.46 | $346.92 | $346.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.98 / $3.28 / $5.08
| Professional | | $2.98 | $3.28 | $5.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.34 / $348.04 / $365.51
| Professional | | $328.34 | $348.04 | $365.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.92 / $302.92 / $328.34
| Professional | | $302.92 | $302.92 | $328.34 |