- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $512.86 / $912.01
| Facility | | $295.12 | $512.86 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $302.00 / $363.08
| Professional | | $295.12 | $302.00 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $331.13 / $691.83
| Facility | | $0.02 | $331.13 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $363.08 / $602.56
| Professional | | $302.00 | $363.08 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $309.03 / $309.03
| Facility | | $251.19 | $309.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $309.03 / $309.03
| Professional | | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $275.42 / $354.81
| Facility | | $177.83 | $275.42 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $363.08
| Professional | | $302.00 | $302.00 | $363.08 |