- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $354.81 / $354.81
| Facility | | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $281.84 / $398.11
| Professional | | $147.91 | $281.84 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $123.03 / $389.05
| Facility | | $102.33 | $123.03 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.85 / $15.85 / $87.10
| Facility | | $15.85 | $15.85 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $10,000.00 / $10,964.78
| Facility | | $7,413.10 | $10,000.00 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,413.10 / $10,000.00 / $10,964.78
| Professional | | $7,413.10 | $10,000.00 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $251.19 / $794.33
| Facility | | $223.87 | $251.19 | $794.33 |