- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.92 / $267.92 / $324.75
| Facility | | $267.92 | $267.92 | $324.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.85 / $296.33 / $1,337.58
| Professional | | $194.85 | $296.33 | $1,337.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $8,639.91 / $79,506.39
| Facility | | $5,000.00 | $8,639.91 | $79,506.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.60 / $463.60 / $463.60
| Professional | | $463.60 | $463.60 | $463.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.25 / $208.25 / $208.25
| Professional | | $208.25 | $208.25 | $208.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.92 / $267.92 / $324.75
| Facility | | $267.92 | $267.92 | $324.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.85 / $296.33 / $1,337.58
| Professional | | $194.85 | $296.33 | $1,337.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.25 / $208.25 / $208.25
| Professional | | $208.25 | $208.25 | $208.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.45 / $441.26 / $441.26
| Facility | | $331.45 | $441.26 | $441.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.45 / $441.26 / $441.26
| Professional | | $331.45 | $441.26 | $441.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.28 / $382.03 / $664.36
| Professional | | $231.28 | $382.03 | $664.36 |