- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $145.66 / $364.15 / $1,572.03
| Facility | | $145.66 | $364.15 | $1,572.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.66 / $214.37 / $233.61
| Professional | | $145.66 | $214.37 | $233.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $268.64 / $605.54 / $1,259.36
| Facility | | $268.64 | $605.54 | $1,259.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.57 / $360.03 / $500.74
| Professional | | $288.57 | $360.03 | $500.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.83 / $274.83 / $8,702.00
| Facility | | $274.83 | $274.83 | $8,702.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.61 / $233.61 / $233.61
| Professional | | $233.61 | $233.61 | $233.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.43 / $164.90 / $280.33
| Professional | | $115.43 | $164.90 | $280.33 |