- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $326.81 / $326.81 / $326.81
| Facility | | $326.81 | $326.81 | $326.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.41 / $351.95 / $508.68
| Professional | | $322.41 | $351.95 | $508.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $788.64 / $1,334.24 / $5,681.33
| Facility | | $788.64 | $1,334.24 | $5,681.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $427.13 / $427.13 / $788.63
| Facility | | $427.13 | $427.13 | $788.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.80 / $427.13 / $765.38
| Professional | | $311.80 | $427.13 | $765.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.26 / $759.35 / $924.42
| Professional | | $561.26 | $759.35 | $924.42 |
- 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
- $858.39 / $858.39 / $858.39
| Professional | | $858.39 | $858.39 | $858.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.10 / $329.41 / $565.49
| Professional | | $251.10 | $329.41 | $565.49 |