- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.16 / $207.16 / $504.40
| Facility | | $207.16 | $207.16 | $504.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.58 / $223.73 / $414.31
| Professional | | $190.58 | $223.73 | $414.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.73 / $281.73 / $281.73
| Professional | | $281.73 | $281.73 | $281.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $473.15 / $473.15 / $473.15
| Facility | | $473.15 | $473.15 | $473.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.16 / $306.16 / $306.16
| Facility | | $306.16 | $306.16 | $306.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.50 / $223.50 / $306.16
| Professional | | $223.50 | $223.50 | $306.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.06 / $2,322.98 / $2,322.98
| Facility | | $2,089.06 | $2,322.98 | $2,322.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,347.44 / $2,347.44 / $3,161.55
| Professional | | $2,347.44 | $2,347.44 | $3,161.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.19 / $329.74 / $473.15
| Facility | | $128.19 | $329.74 | $473.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.65 / $425.84 / $473.15
| Professional | | $129.65 | $425.84 | $473.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.19 / $316.14 / $473.15
| Facility | | $128.19 | $316.14 | $473.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.50 / $223.50 / $326.39
| Professional | | $223.50 | $223.50 | $326.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.49 / $244.81 / $299.20
| Professional | | $165.49 | $244.81 | $299.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.07 / $240.86 / $473.15
| Professional | | $240.07 | $240.86 | $473.15 |