- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $602.56 / $2,511.89
| Facility | | $275.42 | $602.56 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $501.19 / $707.95
| Professional | | $245.47 | $501.19 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $275.42 / $338.84
| Facility | | $275.42 | $275.42 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $302.00
| Professional | | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $446.68 / $1,659.59
| Facility | | $446.68 | $446.68 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $562.34 / $5,888.44
| Professional | | $251.19 | $562.34 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $9,772.37
| Facility | | $2,454.71 | $2,454.71 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $457.09 / $1,548.82
| Professional | | $234.42 | $457.09 | $1,548.82 |