- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $218.78 / $346.74
| Professional | | $181.97 | $218.78 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $263.03 / $263.03
| Facility | | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $194.98 / $281.84
| Professional | | $194.98 | $194.98 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $323.59 / $363.08
| Facility | | $100.00 | $323.59 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $363.08 / $1,122.02
| Professional | | $354.81 | $363.08 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $363.08 / $380.19
| Facility | | $316.23 | $363.08 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $363.08 / $371.54
| Professional | | $295.12 | $363.08 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $380.19
| Facility | | $100.00 | $100.00 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $263.03 / $346.74
| Professional | | $60.26 | $263.03 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $229.09
| Facility | | $204.17 | $204.17 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $186.21 / $741.31
| Professional | | $181.97 | $186.21 | $741.31 |