- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $223.87 / $223.87
| Facility | | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $323.59 / $812.83
| Professional | | $218.78 | $323.59 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $104.71 / $104.71 / $104.71
| Professional | 52 | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $1,862.09
| Facility | | $1,862.09 | $1,862.09 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $380.19 / $1,905.46
| Professional | | $239.88 | $380.19 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $562.34 / $776.25
| Professional | | $338.84 | $562.34 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $389.05 / $812.83
| Professional | | $234.42 | $389.05 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $316.23 / $316.23
| Facility | | $316.23 | $316.23 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $316.23 / $562.34
| Professional | | $173.78 | $316.23 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $588.84 / $870.96
| Professional | | $316.23 | $588.84 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $467.74 / $489.78
| Professional | | $288.40 | $467.74 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $1,862.09
| Facility | | $1,862.09 | $1,862.09 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $380.19 / $1,905.46
| Professional | | $239.88 | $380.19 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $371.54 / $831.76
| Professional | | $229.09 | $371.54 | $831.76 |