- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $484.40 / $484.40 / $540.72
| Facility | | $484.40 | $484.40 | $540.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.72 / $563.79 / $1,169.36
| Professional | | $540.72 | $563.79 | $1,169.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $278.14 / $334.98 / $885.66
| Facility | | $278.14 | $334.98 | $885.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $678.55 / $1,284.27 / $3,422.57
| Professional | | $678.55 | $1,284.27 | $3,422.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $96.60 / $208.99 / $373.20
| Facility | | $96.60 | $208.99 | $373.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.11 / $93.11 / $121.19
| Professional | | $93.11 | $93.11 | $121.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.93 / $638.07 / $801.00
| Professional | | $393.93 | $638.07 | $801.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.00 / $100.00 / $2,074.00
| Facility | | $65.00 | $100.00 | $2,074.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.62 / $307.62 / $2,383.73
| Professional | | $307.62 | $307.62 | $2,383.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.61 / $176.54 / $1,035.69
| Facility | | $151.61 | $176.54 | $1,035.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.11 / $109.54 / $168.03
| Professional | | $93.11 | $109.54 | $168.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.20 / $79.59 / $576.75
| Professional | | $69.20 | $79.59 | $576.75 |