- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $461.62 / $503.67 / $1,715.66
| Facility | | $461.62 | $503.67 | $1,715.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.62 / $461.62 / $503.67
| Professional | | $461.62 | $461.62 | $503.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $260.82 / $607.80 / $6,567.00
| Facility | | $260.82 | $607.80 | $6,567.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.51 / $548.51 / $548.51
| Professional | | $548.51 | $548.51 | $548.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.88 / $506.88 / $506.88
| Facility | | $506.88 | $506.88 | $506.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.88 / $506.88 / $506.88
| Professional | | $506.88 | $506.88 | $506.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.82 / $22.23 / $898.97
| Professional | | $14.82 | $22.23 | $898.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.51 / $17.64 / $19.27
| Professional | | $17.51 | $17.64 | $19.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.57 / $534.03 / $556.66
| Professional | | $452.57 | $534.03 | $556.66 |