- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $786.37 / $942.23 / $2,132.24
| Facility | | $786.37 | $942.23 | $2,132.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.32 / $798.38 / $798.38
| Professional | | $410.32 | $798.38 | $798.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $357.00 / $812.79 / $1,480.24
| Facility | | $357.00 | $812.79 | $1,480.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $33.00
| Professional | | $30.00 | $30.00 | $33.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.54 / $478.54 / $478.54
| Facility | | $478.54 | $478.54 | $478.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.51 / $291.51 / $291.51
| Professional | | $291.51 | $291.51 | $291.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.40 / $440.40 / $440.40
| Professional | | $440.40 | $440.40 | $440.40 |