- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $741.31 / $977.24
| Professional | | $630.96 | $741.31 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $128.82 / $128.82
| Facility | | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $95.50 / $95.50
| Professional | | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $851.14 / $1,000.00
| Professional | | $100.00 | $851.14 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $363.08 / $776.25
| Facility | | $51.29 | $363.08 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $446.68 / $831.76
| Professional | | $407.38 | $446.68 | $831.76 |