- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $339.76 / $411.78 / $886.77
| Facility | | $339.76 | $411.78 | $886.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.76 / $340.31 / $411.79
| Professional | | $339.76 | $340.31 | $411.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,330.33 / $43,116.50 / $122,765.11
| Facility | | $1,330.33 | $43,116.50 | $122,765.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $328.91 / $340.31 / $340.31
| Facility | | $328.91 | $340.31 | $340.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.31 / $340.31 / $353.16
| Professional | | $340.31 | $340.31 | $353.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.26 / $467.43 / $689.35
| Professional | | $289.26 | $467.43 | $689.35 |
- 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
- $442.40 / $442.40 / $442.40
| Professional | | $442.40 | $442.40 | $442.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.60 / $340.31 / $361.71
| Professional | | $337.60 | $340.31 | $361.71 |