- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $278.26 / $347.82 / $2,008.08
| Facility | | $278.26 | $347.82 | $2,008.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.26 / $301.44 / $333.91
| Professional | | $278.26 | $301.44 | $333.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.91 / $320.47 / $1,744.32
| Facility | | $228.91 | $320.47 | $1,744.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.17 / $565.40 / $706.75
| Professional | | $533.17 | $565.40 | $706.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.39 / $278.26 / $549.51
| Professional | | $263.39 | $278.26 | $549.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.00 / $70.00 / $70.00
| Professional | | $70.00 | $70.00 | $70.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $695.64 / $695.64 / $695.64
| Facility | | $695.64 | $695.64 | $695.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.32 / $194.78 / $603.60
| Professional | | $162.32 | $194.78 | $603.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.23 / $278.26 / $278.26
| Professional | | $240.23 | $278.26 | $278.26 |