- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $255.14 / $264.83 / $1,436.54
| Facility | | $255.14 | $264.83 | $1,436.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.14 / $264.83 / $322.95
| Professional | | $255.14 | $264.83 | $322.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $201.04 / $290.66 / $339.43
| Facility | | $201.04 | $290.66 | $339.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.80 / $6.83 / $12.64
| Professional | | $5.80 | $6.83 | $12.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $322.95 / $532.88 / $41,999.58
| Facility | | $322.95 | $532.88 | $41,999.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.26 / $452.14 / $5,987.78
| Professional | | $355.26 | $452.14 | $5,987.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.92 / $246.45 / $387.55
| Facility | | $209.92 | $246.45 | $387.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.27 / $463.59 / $1,556.67
| Professional | | $363.27 | $463.59 | $1,556.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Professional | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.63 / $215.31 / $358.85
| Professional | | $135.63 | $215.31 | $358.85 |