- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $371.54 / $371.54
| Facility | | $213.80 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $245.47 / $389.05
| Professional | | $181.97 | $245.47 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $489.78 / $933.25
| Facility | | $436.52 | $489.78 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $331.13
| Professional | | $245.47 | $245.47 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $302.00
| Facility | | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $218.78 / $309.03
| Professional | | $218.78 | $218.78 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $436.52 / $1,000.00
| Professional | | $263.03 | $436.52 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $436.52 / $436.52
| Professional | | $426.58 | $436.52 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.33 / $269.15 / $316.23
| Facility | | $0.33 | $269.15 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $204.17 / $309.03
| Professional | | $186.21 | $204.17 | $309.03 |