- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.64 / $191.14 / $191.14
| Facility | | $110.64 | $191.14 | $191.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.50 / $191.14 / $295.23
| Professional | | $127.50 | $191.14 | $295.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.36 / $346.70 / $586.27
| Professional | | $277.36 | $346.70 | $586.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.28 / $280.93 / $513.97
| Facility | | $147.28 | $280.93 | $513.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.24 / $536.78 / $3,577.25
| Professional | | $237.24 | $536.78 | $3,577.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.92 / $398.35 / $1,239.49
| Facility | | $300.92 | $398.35 | $1,239.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.10 / $366.03 / $531.61
| Professional | | $267.10 | $366.03 | $531.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.00 / $289.27 / $392.67
| Professional | | $177.00 | $289.27 | $392.67 |
- 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
- $237.24 / $395.40 / $560.80
| Professional | | $237.24 | $395.40 | $560.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.40 / $283.10 / $468.20
| Professional | | $231.40 | $283.10 | $468.20 |