- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $374.17 / $397.20 / $564.14
| Facility | | $374.17 | $397.20 | $564.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.10 / $397.20 / $575.65
| Professional | | $315.10 | $397.20 | $575.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.59 / $1,029.43 / $1,447.01
| Facility | | $602.59 | $1,029.43 | $1,447.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.94 / $491.54 / $491.54
| Professional | | $410.94 | $491.54 | $491.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Facility | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $432.60 / $432.60 / $432.60
| Facility | | $432.60 | $432.60 | $432.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.80 / $432.60 / $432.60
| Professional | | $315.80 | $432.60 | $432.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.55 / $456.41 / $460.52
| Facility | | $0.55 | $456.41 | $460.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.26 / $352.07 / $532.23
| Professional | | $230.26 | $352.07 | $532.23 |