- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $394.41 / $394.41 / $394.41
| Facility | | $394.41 | $394.41 | $394.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.41 / $258.41 / $394.41
| Professional | | $153.41 | $258.41 | $394.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $336.71 / $367.37 / $389.67
| Facility | | $336.71 | $367.37 | $389.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.64 / $364.64 / $364.64
| Professional | | $364.64 | $364.64 | $364.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.62 / $297.62 / $297.62
| Facility | | $297.62 | $297.62 | $297.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.26 / $297.62 / $792.19
| Professional | | $217.26 | $297.62 | $792.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.41 / $383.86 / $2,544.94
| Facility | | $153.41 | $383.86 | $2,544.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.41 / $237.62 / $608.50
| Professional | | $158.41 | $237.62 | $608.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.41 / $237.62 / $318.25
| Professional | | $158.41 | $237.62 | $318.25 |