- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.21 / $309.87 / $309.87
| Facility | | $153.21 | $309.87 | $309.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.06 / $249.53 / $309.87
| Professional | | $137.06 | $249.53 | $309.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.68 / $479.17 / $823.90
| Professional | | $332.68 | $479.17 | $823.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $180.18 / $343.68 / $684.62
| Facility | | $180.18 | $343.68 | $684.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.17 / $607.63 / $2,133.60
| Professional | | $315.17 | $607.63 | $2,133.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $336.37 / $450.57 / $733.19
| Facility | | $336.37 | $450.57 | $733.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.33 / $490.38 / $758.62
| Professional | | $325.33 | $490.38 | $758.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.59 / $329.11 / $553.75
| Professional | | $215.59 | $329.11 | $553.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,000.00 / $2,000.00
| Facility | | $2,000.00 | $2,000.00 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.17 / $525.28 / $769.78
| Professional | | $315.17 | $525.28 | $769.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.50 / $337.00 / $645.40
| Professional | | $275.50 | $337.00 | $645.40 |