- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.66 / $641.70 / $1,121.70
| Facility | | $231.66 | $641.70 | $1,121.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.74 / $231.66 / $286.52
| Professional | | $103.74 | $231.66 | $286.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $322.12 / $850.42 / $1,402.13
| Facility | | $322.12 | $850.42 | $1,402.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.02 / $128.02 / $304.81
| Professional | | $128.02 | $128.02 | $304.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $174.35 / $204.07 / $931.21
| Facility | | $174.35 | $204.07 | $931.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.76 / $163.16 / $457.43
| Professional | | $141.76 | $163.16 | $457.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.66 / $304.81 / $426.73
| Facility | | $231.66 | $304.81 | $426.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.85 / $432.83 / $890.00
| Professional | | $243.85 | $432.83 | $890.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.02 / $128.02 / $182.89
| Professional | | $128.02 | $128.02 | $182.89 |