- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.12 / $599.12 / $599.12
| Facility | | $599.12 | $599.12 | $599.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.65 / $222.65 / $240.34
| Professional | | $222.65 | $222.65 | $240.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.00 / $339.00 / $423.75
| Professional | | $339.00 | $339.00 | $423.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.04 / $141.97 / $260.27
| Professional | | $136.04 | $141.97 | $260.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.58 / $300.58 / $393.04
| Professional | | $300.58 | $300.58 | $393.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.19 / $617.34 / $701.53
| Professional | | $475.19 | $617.34 | $701.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.97 / $221.55 / $333.47
| Professional | | $141.97 | $221.55 | $333.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $387.00 / $387.00 / $387.00
| Facility | | $387.00 | $387.00 | $387.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.00 / $387.00 / $387.00
| Professional | | $387.00 | $387.00 | $387.00 |