- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $691.83 / $1,096.48
| Facility | | $371.54 | $691.83 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $295.12 / $416.87
| Professional | | $239.88 | $295.12 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $489.78 / $588.84
| Facility | | $436.52 | $489.78 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $676.08 / $1,659.59
| Facility | | $234.42 | $676.08 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $436.52 / $524.81
| Professional | | $416.87 | $436.52 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $380.19 / $562.34
| Professional | | $125.89 | $380.19 | $562.34 |
- 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
- $363.08 / $363.08 / $724.44
| Facility | | $363.08 | $363.08 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $218.78 / $363.08
| Professional | | $151.36 | $218.78 | $363.08 |