- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $346.74 / $602.56
| Facility | | $204.17 | $346.74 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $173.78 / $331.13
| Professional | | $138.04 | $173.78 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $707.95 / $2,511.89
| Facility | | $245.47 | $707.95 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.47 / $141.25 / $154.88
| Professional | | $3.47 | $141.25 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $426.58 / $933.25
| Facility | | $131.83 | $426.58 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $234.42 / $338.84
| Professional | | $91.20 | $234.42 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $354.81 / $1,513.56
| Professional | | $204.17 | $354.81 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $263.03 / $263.03
| Professional | | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $407.38
| Facility | | $204.17 | $204.17 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $120.23 / $204.17
| Professional | | $85.11 | $120.23 | $204.17 |