- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.05 / $230.72 / $1,402.78
| Facility | | $207.05 | $230.72 | $1,402.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.47 / $230.72 / $236.63
| Professional | | $177.47 | $230.72 | $236.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,821.01 / $1,821.01 / $1,946.07
| Facility | | $1,821.01 | $1,821.01 | $1,946.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.00 / $282.73 / $404.49
| Professional | | $266.00 | $282.73 | $404.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.55 / $857.48 / $1,686.50
| Facility | | $537.55 | $857.48 | $1,686.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.86 / $140.55 / $404.58
| Professional | | $134.86 | $140.55 | $404.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.72 / $295.79 / $428.90
| Facility | | $230.72 | $295.79 | $428.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.68 / $162.68 / $162.68
| Professional | | $162.68 | $162.68 | $162.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.23 / $162.68 / $295.79
| Professional | | $124.23 | $162.68 | $295.79 |