- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.83 / $265.54 / $1,259.71
| Professional | | $194.83 | $265.54 | $1,259.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $318.35 / $318.35 / $318.35
| Facility | | $318.35 | $318.35 | $318.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.40 / $232.40 / $318.35
| Professional | | $232.40 | $232.40 | $318.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.62 / $846.57 / $1,104.14
| Professional | | $305.62 | $846.57 | $1,104.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.54 / $372.16 / $436.60
| Facility | | $265.54 | $372.16 | $436.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.62 / $410.40 / $458.43
| Professional | | $324.62 | $410.40 | $458.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $392.94 / $436.60 / $497.43
| Facility | | $392.94 | $436.60 | $497.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.84 / $346.84 / $346.84
| Professional | | $346.84 | $346.84 | $346.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.54 / $382.31 / $458.43
| Facility | | $265.54 | $382.31 | $458.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.40 / $382.31 / $480.26
| Professional | | $232.40 | $382.31 | $480.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.76 / $726.06 / $1,531.76
| Facility | | $363.76 | $726.06 | $1,531.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.48 / $480.26 / $480.26
| Professional | | $375.48 | $480.26 | $480.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.47 / $199.36 / $380.35
| Professional | | $190.47 | $199.36 | $380.35 |