- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $489.78 / $954.99
| Facility | | $218.78 | $489.78 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,000.00 / $3,467.37
| Facility | | $309.03 | $1,000.00 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $562.34 / $870.96
| Facility | | $398.11 | $562.34 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $426.58 / $1,380.38
| Professional | | $229.09 | $426.58 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $812.83 / $2,344.23
| Facility | | $154.88 | $812.83 | $2,344.23 |