- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.42 / $435.74 / $508.78
| Facility | | $307.42 | $435.74 | $508.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.99 / $307.42 / $343.20
| Professional | | $203.99 | $307.42 | $343.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,085.22 / $1,085.22 / $1,085.22
| Facility | | $1,085.22 | $1,085.22 | $1,085.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.54 / $436.40 / $436.40
| Professional | | $433.54 | $436.40 | $436.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.63 / $65.98 / $92.29
| Facility | | $39.63 | $65.98 | $92.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.88 / $254.00 / $317.49
| Professional | | $103.88 | $254.00 | $317.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.79 / $307.42 / $307.42
| Facility | | $250.79 | $307.42 | $307.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.00 / $315.00 / $358.00
| Professional | | $210.00 | $315.00 | $358.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.66 / $60.16 / $61.38
| Facility | | $57.66 | $60.16 | $61.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $491.40 / $491.40 / $491.40
| Facility | | $491.40 | $491.40 | $491.40 |