- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $424.40 / $608.66 / $8,022.14
| Facility | | $424.40 | $608.66 | $8,022.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.93 / $212.15 / $284.08
| Professional | | $149.93 | $212.15 | $284.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.63 / $158.63 / $2,151.00
| Facility | | $158.63 | $158.63 | $2,151.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.55 / $230.63 / $378.92
| Professional | | $154.55 | $230.63 | $378.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $414.00 / $1,320.00
| Facility | | $100.00 | $414.00 | $1,320.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.48 / $243.10 / $525.83
| Professional | | $194.48 | $243.10 | $525.83 |