- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.35 / $494.35 / $494.35
| Facility | | $494.35 | $494.35 | $494.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.41 / $453.90 / $494.35
| Professional | | $449.41 | $453.90 | $494.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.47 / $327.16 / $809.07
| Facility | | $138.47 | $327.16 | $809.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.63 / $173.10 / $408.94
| Professional | | $140.63 | $173.10 | $408.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $449.41 / $449.41 / $449.41
| Facility | | $449.41 | $449.41 | $449.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.41 / $449.41 / $449.41
| Professional | | $449.41 | $449.41 | $449.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.49 / $585.21 / $1,125.71
| Facility | | $471.49 | $585.21 | $1,125.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.65 / $483.65 / $1,049.52
| Professional | | $483.65 | $483.65 | $1,049.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.41 / $449.41 / $449.41
| Professional | | $449.41 | $449.41 | $449.41 |