- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.80 / $412.99 / $412.99
| Professional | | $240.80 | $412.99 | $412.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.99 / $193.01 / $549.00
| Professional | | $185.99 | $193.01 | $549.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $296.00 / $296.00 / $296.00
| Facility | | $296.00 | $296.00 | $296.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.60 / $251.60 / $296.00
| Professional | | $251.60 | $251.60 | $296.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.00 / $365.00 / $365.00
| Professional | | $365.00 | $365.00 | $365.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.80 / $412.99 / $446.74
| Professional | | $240.80 | $412.99 | $446.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $296.00 / $296.00 / $296.00
| Facility | | $296.00 | $296.00 | $296.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.60 / $251.60 / $296.00
| Professional | | $251.60 | $251.60 | $296.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $884.84 / $884.84 / $884.84
| Professional | | $884.84 | $884.84 | $884.84 |