- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $476.70 / $476.70 / $476.70
| Facility | | $476.70 | $476.70 | $476.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.36 / $476.70 / $482.25
| Professional | | $228.36 | $476.70 | $482.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.25 / $956.46 / $1,736.55
| Facility | | $851.25 | $956.46 | $1,736.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.02 / $375.02 / $392.12
| Professional | | $375.02 | $375.02 | $392.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.16 / $400.16 / $400.16
| Facility | | $400.16 | $400.16 | $400.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.12 / $292.12 / $685.26
| Professional | | $292.12 | $292.12 | $685.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.26 / $476.70 / $1,064.06
| Facility | | $206.26 | $476.70 | $1,064.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.26 / $206.26 / $206.26
| Professional | | $206.26 | $206.26 | $206.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $621.41 / $1,064.06 / $1,685.48
| Professional | | $621.41 | $1,064.06 | $1,685.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.10 / $319.49 / $481.27
| Professional | | $290.10 | $319.49 | $481.27 |