- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.36 / $776.32 / $3,368.10
| Facility | | $437.36 | $776.32 | $3,368.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.12 / $769.03 / $1,037.60
| Professional | | $337.12 | $769.03 | $1,037.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.36 / $270.36 / $270.36
| Professional | | $270.36 | $270.36 | $270.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,310.00 / $1,310.00 / $1,545.00
| Facility | | $1,310.00 | $1,310.00 | $1,545.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.17 / $554.49 / $588.07
| Professional | | $344.17 | $554.49 | $588.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.40 / $6.40 / $32.00
| Professional | | $6.40 | $6.40 | $32.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $639.30 / $639.30 / $639.30
| Facility | | $639.30 | $639.30 | $639.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.40 / $6.40 / $6.40
| Professional | | $6.40 | $6.40 | $6.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $448.20 / $684.35
| Professional | | $30.00 | $448.20 | $684.35 |