- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $258.76 / $264.05 / $278.77
| Facility | | $258.76 | $264.05 | $278.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.27 / $258.76 / $264.05
| Professional | | $153.27 | $258.76 | $264.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.50 / $315.00 / $957.00
| Facility | | $274.50 | $315.00 | $957.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.05 / $264.05 / $300.00
| Professional | | $264.05 | $264.05 | $300.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.00 / $306.00 / $306.00
| Facility | | $306.00 | $306.00 | $306.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.00 / $306.00 / $306.00
| Professional | | $306.00 | $306.00 | $306.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.75 / $360.00 / $360.00
| Professional | | $328.75 | $360.00 | $360.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.00 / $300.00 / $300.00
| Professional | | $300.00 | $300.00 | $300.00 |