- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $1,288.25
| Facility | | $467.74 | $467.74 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $138.04 / $162.18
| Professional | | $100.00 | $138.04 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $354.81 / $1,071.52
| Facility | | $316.23 | $354.81 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $120.23 / $229.09
| Professional | | $120.23 | $120.23 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $575.44 / $812.83
| Facility | | $302.00 | $575.44 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $186.21 / $354.81
| Professional | | $186.21 | $186.21 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $112.20 / $194.98
| Professional | | $112.20 | $112.20 | $194.98 |