- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.79 / $245.44 / $1,224.76
| Facility | | $225.79 | $245.44 | $1,224.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.28 / $220.28 / $245.44
| Professional | | $220.28 | $220.28 | $245.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.84 / $63.35 / $432.29
| Professional | | $53.84 | $63.35 | $432.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.42 / $3,613.97 / $8,690.77
| Facility | | $330.42 | $3,613.97 | $8,690.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.64 / $385.49 / $5,105.82
| Professional | | $316.64 | $385.49 | $5,105.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.98 / $214.25 / $363.33
| Facility | | $178.98 | $214.25 | $363.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.52 / $1,327.19 / $1,327.19
| Professional | | $319.52 | $1,327.19 | $1,327.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $100.00 / $100.00
| Professional | | $45.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.65 / $165.21 / $275.35
| Professional | | $115.65 | $165.21 | $275.35 |