- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $295.12 / $707.95
| Facility | | $218.78 | $295.12 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $281.84 / $398.11
| Professional | | $218.78 | $281.84 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $426.58 / $851.14
| Facility | | $331.13 | $426.58 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $331.13 / $549.54
| Professional | | $263.03 | $331.13 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $645.65 / $1,000.00
| Facility | | $331.13 | $645.65 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $295.12 / $977.24
| Professional | | $151.36 | $295.12 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $426.58 / $2,570.40
| Professional | | $295.12 | $426.58 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $407.38 / $707.95
| Professional | | $331.13 | $407.38 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $295.12 / $331.13
| Facility | | $295.12 | $295.12 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $199.53 / $457.09
| Professional | | $138.04 | $199.53 | $457.09 |