- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.78 / $416.78 / $625.16
| Facility | | $416.78 | $416.78 | $625.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.78 / $416.78 / $416.78
| Professional | | $416.78 | $416.78 | $416.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.24 / $226.23 / $397.34
| Facility | | $162.24 | $226.23 | $397.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.50 / $150.00 / $160.50
| Professional | | $142.50 | $150.00 | $160.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.78 / $416.80 / $521.00
| Professional | | $416.78 | $416.80 | $521.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.11 / $416.78 / $765.83
| Facility | | $400.11 | $416.78 | $765.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.11 / $416.78 / $500.14
| Professional | | $400.11 | $416.78 | $500.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Professional | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.07 / $228.81 / $417.48
| Professional | | $175.07 | $228.81 | $417.48 |