- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $196.28 / $196.28 / $196.28
| Facility | | $196.28 | $196.28 | $196.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.40 / $196.28 / $213.61
| Professional | | $177.40 | $196.28 | $213.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.97 / $469.02 / $586.27
| Professional | | $340.97 | $469.02 | $586.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $205.53 / $354.80 / $598.30
| Facility | | $205.53 | $354.80 | $598.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.82 / $409.28 / $1,798.05
| Professional | | $256.82 | $409.28 | $1,798.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $334.68 / $500.82 / $646.55
| Facility | | $334.68 | $500.82 | $646.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.00 / $458.51 / $559.66
| Professional | | $330.00 | $458.51 | $559.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.54 / $357.46 / $407.55
| Professional | | $241.54 | $357.46 | $407.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,000.00 / $2,000.00
| Facility | | $2,000.00 | $2,000.00 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.42 / $416.76 / $593.26
| Professional | | $235.42 | $416.76 | $593.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.30 / $494.70 / $494.70
| Professional | | $404.30 | $494.70 | $494.70 |