- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.82 / $471.82 / $794.24
| Facility | | $471.82 | $471.82 | $794.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.29 / $513.42 / $794.24
| Professional | | $441.29 | $513.42 | $794.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.00 / $193.00 / $193.00
| Professional | | $193.00 | $193.00 | $193.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.75 / $509.12 / $783.26
| Professional | | $315.75 | $509.12 | $783.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.00 / $25.00 / $50.00
| Professional | | $17.00 | $25.00 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.63 / $561.27 / $774.86
| Professional | | $391.63 | $561.27 | $774.86 |