- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.43 / $175.61 / $175.61
| Facility | | $139.43 | $175.61 | $175.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.37 / $142.55 / $230.16
| Professional | | $117.37 | $142.55 | $230.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.69 / $375.92 / $471.36
| Professional | | $271.69 | $375.92 | $471.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $122.27 / $206.02 / $392.97
| Facility | | $122.27 | $206.02 | $392.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.41 / $309.91 / $979.76
| Professional | | $141.41 | $309.91 | $979.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $159.06 / $327.41 / $426.33
| Facility | | $159.06 | $327.41 | $426.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.77 / $346.97 / $435.96
| Professional | | $273.77 | $346.97 | $435.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.69 / $253.58 / $315.69
| Professional | | $164.69 | $253.58 | $315.69 |
- 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
- $177.46 / $294.14 / $457.55
| Professional | | $177.46 | $294.14 | $457.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.70 / $302.39 / $376.40
| Professional | | $290.70 | $302.39 | $376.40 |