- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,854.80 / $3,369.56 / $7,982.86
| Facility | | $2,854.80 | $3,369.56 | $7,982.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.84 / $207.86 / $808.12
| Professional | | $189.84 | $207.86 | $808.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $429.36 / $472.32 / $553.83
| Professional | | $429.36 | $472.32 | $553.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.22 / $440.94 / $669.85
| Professional | | $228.22 | $440.94 | $669.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.86 / $336.98 / $3,481.18
| Facility | | $207.86 | $336.98 | $3,481.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.97 / $381.32 / $1,603.12
| Professional | | $198.97 | $381.32 | $1,603.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,530.00 / $1,530.00 / $1,530.00
| Facility | | $1,530.00 | $1,530.00 | $1,530.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.44 / $374.54 / $540.67
| Professional | | $194.44 | $374.54 | $540.67 |