- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.00 / $326.67 / $326.67
| Professional | | $196.00 | $326.67 | $326.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $291.02 / $291.02 / $311.98
| Facility | | $291.02 | $291.02 | $311.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.45 / $291.02 / $310.26
| Professional | | $212.45 | $291.02 | $310.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.15 / $262.77 / $373.06
| Facility | | $120.15 | $262.77 | $373.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.75 / $354.41 / $373.06
| Professional | | $335.75 | $354.41 | $373.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $278.70 / $335.75
| Professional | | $30.00 | $278.70 | $335.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $326.67 / $364.32 / $546.48
| Facility | | $326.67 | $364.32 | $546.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.14 / $261.14 / $391.71
| Professional | | $261.14 | $261.14 | $391.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.30 / $211.05 / $217.13
| Facility | | $0.30 | $211.05 | $217.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.08 / $186.11 / $289.08
| Professional | | $172.08 | $186.11 | $289.08 |