- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.66 / $257.02 / $1,562.68
| Facility | | $230.66 | $257.02 | $1,562.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.02 / $257.02 / $286.67
| Professional | | $257.02 | $257.02 | $286.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,028.61 / $2,028.61 / $2,167.92
| Facility | | $2,028.61 | $2,028.61 | $2,167.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.51 / $330.00 / $454.72
| Professional | | $329.51 | $330.00 | $454.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $598.85 / $811.74 / $1,878.79
| Facility | | $598.85 | $811.74 | $1,878.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.54 / $156.65 / $450.61
| Professional | | $149.54 | $156.65 | $450.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.02 / $329.51 / $477.79
| Facility | | $257.02 | $329.51 | $477.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.23 / $181.23 / $181.23
| Professional | | $181.23 | $181.23 | $181.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.38 / $181.23 / $329.51
| Professional | | $138.38 | $181.23 | $329.51 |