- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $197.21 / $394.09 / $717.45
| Facility | | $197.21 | $394.09 | $717.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.21 / $197.21 / $245.03
| Professional | | $197.21 | $197.21 | $245.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.00 / $276.14 / $359.65
| Professional | | $263.00 | $276.14 | $359.65 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $4.59 / $14.07 / $264.25
| Facility | | $4.59 | $14.07 | $264.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.00 / $300.00 / $300.00
| Professional | | $300.00 | $300.00 | $300.00 |