- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $549.54 / $4,073.80
| Facility | | $407.38 | $549.54 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $229.09 / $562.34
| Professional | | $165.96 | $229.09 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $223.87 / $316.23
| Professional | | $165.96 | $223.87 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $12,302.69
| Facility | | $10,000.00 | $10,000.00 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $204.17 / $316.23
| Professional | | $144.54 | $204.17 | $316.23 |