- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.48 / $231.96 / $1,258.23
| Facility | | $223.48 | $231.96 | $1,258.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.02 / $226.30 / $282.88
| Professional | | $198.02 | $226.30 | $282.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.88 / $335.33 / $444.12
| Professional | | $282.88 | $335.33 | $444.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $339.46 / $2,970.24 / $8,935.92
| Facility | | $339.46 | $2,970.24 | $8,935.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.31 / $396.03 / $7,818.93
| Professional | | $325.31 | $396.03 | $7,818.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $183.87 / $220.11 / $373.26
| Facility | | $183.87 | $220.11 | $373.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.70 / $1,363.48 / $1,363.48
| Professional | | $328.70 | $1,363.48 | $1,363.48 |
- 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
- $118.81 / $169.73 / $311.17
| Professional | | $118.81 | $169.73 | $311.17 |