- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.12 / $220.12 / $1,035.45
| Facility | | $220.12 | $220.12 | $1,035.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.34 / $227.63 / $254.56
| Professional | | $198.34 | $227.63 | $254.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.52 / $243.59 / $529.76
| Professional | | $195.52 | $243.59 | $529.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $921.76 / $1,249.96 / $1,810.61
| Facility | | $921.76 | $1,249.96 | $1,810.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.00 / $250.00 / $250.00
| Professional | | $250.00 | $250.00 | $250.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $561.45 / $561.45 / $561.45
| Facility | | $561.45 | $561.45 | $561.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.91 / $314.94 / $418.00
| Professional | | $160.91 | $314.94 | $418.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.12 / $224.71 / $323.89
| Facility | | $220.12 | $224.71 | $323.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.14 / $286.63 / $1,550.91
| Professional | | $215.14 | $286.63 | $1,550.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.07 / $265.76 / $455.58
| Professional | | $210.07 | $265.76 | $455.58 |