- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.30 / $258.60 / $400.00
| Professional | | $192.30 | $258.60 | $400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.57 / $323.57 / $485.73
| Professional | | $323.57 | $323.57 | $485.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.06 / $292.94 / $390.60
| Facility | | $39.06 | $292.94 | $390.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.06 / $292.94 / $390.60
| Professional | | $39.06 | $292.94 | $390.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.97 / $265.97 / $265.97
| Facility | | $265.97 | $265.97 | $265.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.07 / $265.97 / $452.63
| Professional | | $226.07 | $265.97 | $452.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $332.00 / $332.00
| Facility | | $319.00 | $332.00 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.02 / $261.13 / $390.35
| Professional | | $242.02 | $261.13 | $390.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.66 / $364.08 / $383.46
| Professional | | $342.66 | $364.08 | $383.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.97 / $265.97 / $265.97
| Facility | | $265.97 | $265.97 | $265.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.07 / $234.80 / $452.63
| Professional | | $226.07 | $234.80 | $452.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.47 / $270.64 / $387.45
| Professional | | $137.47 | $270.64 | $387.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $342.66 / $342.66 / $342.66
| Facility | | $342.66 | $342.66 | $342.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.66 / $342.66 / $383.46
| Professional | | $342.66 | $342.66 | $383.46 |