- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $331.13
| Facility | | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $407.38 / $602.56
| Professional | | $316.23 | $407.38 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $741.31 / $870.96
| Professional | | $436.52 | $741.31 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $524.81 / $1,258.93
| Facility | | $331.13 | $524.81 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $389.05 / $954.99
| Professional | | $389.05 | $389.05 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $446.68 / $501.19
| Professional | | $380.19 | $446.68 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $562.34 / $1,148.15
| Facility | | $331.13 | $562.34 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $239.88 / $239.88
| Professional | | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $501.19
| Professional | | $30.20 | $30.20 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $562.34 / $1,000.00
| Facility | | $275.42 | $562.34 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $371.54 / $562.34
| Professional | | $288.40 | $371.54 | $562.34 |