- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $302.00 / $524.81
| Facility | | $177.83 | $302.00 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $144.54 / $199.53
| Professional | | $117.49 | $144.54 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $234.42 / $281.84
| Facility | | $208.93 | $234.42 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $173.78 / $173.78
| Professional | | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $323.59 / $891.25
| Facility | | $114.82 | $323.59 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $213.80 / $257.04
| Professional | | $204.17 | $213.80 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $245.47 / $346.74
| Professional | | $173.78 | $245.47 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $173.78 / $346.74
| Facility | | $173.78 | $173.78 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $104.71 / $173.78
| Professional | | $74.13 | $104.71 | $173.78 |