- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $305.35 / $305.35 / $305.35
| Facility | | $305.35 | $305.35 | $305.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.40 / $212.59 / $340.14
| Professional | | $123.40 | $212.59 | $340.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.98 / $267.27 / $283.51
| Facility | | $244.98 | $267.27 | $283.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.30 / $265.30 / $265.30
| Professional | | $265.30 | $265.30 | $265.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $305.27 / $305.27 / $305.27
| Facility | | $305.27 | $305.27 | $305.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.85 / $305.27 / $637.03
| Professional | | $222.85 | $305.27 | $637.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.40 / $327.27 / $2,036.64
| Facility | | $123.40 | $327.27 | $2,036.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.44 / $232.51 / $518.79
| Professional | | $127.44 | $232.51 | $518.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.06 / $202.59 / $294.56
| Professional | | $135.06 | $202.59 | $294.56 |