- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $292.02 / $445.16 / $534.20
| Facility | | $292.02 | $445.16 | $534.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.10 / $292.02 / $302.70
| Professional | | $267.10 | $292.02 | $302.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.78 / $2,003.23 / $9,615.52
| Facility | | $480.78 | $2,003.23 | $9,615.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.36 / $480.78 / $119,998.80
| Professional | | $427.36 | $480.78 | $119,998.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $289.35 / $427.36 / $1,068.28
| Facility | | $289.35 | $427.36 | $1,068.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,716.55 / $1,716.55 / $1,716.55
| Professional | | $1,716.55 | $1,716.55 | $1,716.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.57 / $178.07 / $516.39
| Professional | | $149.57 | $178.07 | $516.39 |