- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $264.18 / $514.69 / $916.85
| Facility | | $264.18 | $514.69 | $916.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $509.64 / $1,101.48 / $4,286.72
| Facility | | $509.64 | $1,101.48 | $4,286.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $401.02 / $454.27 / $869.17
| Facility | | $401.02 | $454.27 | $869.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.40 / $424.27 / $1,072.58
| Professional | | $234.40 | $424.27 | $1,072.58 |
- 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
- $165.00 / $900.00 / $3,686.00
| Facility | | $165.00 | $900.00 | $3,686.00 |