- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.66 / $461.01 / $652.04
| Facility | | $288.66 | $461.01 | $652.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.00 / $312.94 / $663.34
| Professional | | $275.00 | $312.94 | $663.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $545.24 / $545.24 / $671.48
| Facility | | $545.24 | $545.24 | $671.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.61 / $264.61 / $302.06
| Professional | | $264.61 | $264.61 | $302.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.55 / $307.55 / $307.55
| Facility | | $307.55 | $307.55 | $307.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.55 / $307.55 / $329.37
| Professional | | $307.55 | $307.55 | $329.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.66 / $362.31 / $372.35
| Facility | | $288.66 | $362.31 | $372.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.64 / $219.64 / $219.64
| Professional | | $219.64 | $219.64 | $219.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.60 / $329.52 / $362.47
| Professional | | $274.60 | $329.52 | $362.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $339.47 / $339.47 / $658.74
| Facility | | $339.47 | $339.47 | $658.74 |