- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $370.50 / $1,488.00 / $3,261.62
| Facility | | $370.50 | $1,488.00 | $3,261.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.75 / $375.00 / $525.00
| Professional | | $318.75 | $375.00 | $525.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.03 / $311.38
| Professional | | $0.02 | $0.03 | $311.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.48 / $545.05 / $1,260.73
| Facility | | $450.48 | $545.05 | $1,260.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.35 / $344.35 / $344.35
| Professional | | $344.35 | $344.35 | $344.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $448.00 / $448.00 / $775.04
| Facility | | $448.00 | $448.00 | $775.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.00 / $260.00 / $260.00
| Professional | | $260.00 | $260.00 | $260.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $452.40 / $545.05 / $1,509.07
| Facility | | $452.40 | $545.05 | $1,509.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.35 / $344.35 / $344.35
| Professional | | $344.35 | $344.35 | $344.35 |