- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $517.29 / $517.29 / $766.35
| Facility | | $517.29 | $517.29 | $766.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.29 / $550.00 / $636.39
| Professional | | $517.29 | $550.00 | $636.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.00 / $400.00 / $400.00
| Professional | | $400.00 | $400.00 | $400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.33 / $317.33 / $317.33
| Professional | | $317.33 | $317.33 | $317.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $517.29 / $517.29 / $646.63
| Facility | | $517.29 | $517.29 | $646.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $438.17 / $517.29 / $636.39
| Facility | | $438.17 | $517.29 | $636.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.25 / $157.25 / $157.25
| Professional | | $157.25 | $157.25 | $157.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $58.40 / $85.00
| Professional | | $50.00 | $58.40 | $85.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $517.29 / $517.29 / $646.63
| Facility | | $517.29 | $517.29 | $646.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.25 / $157.25 / $157.25
| Professional | | $157.25 | $157.25 | $157.25 |