- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $537.03 / $2,454.71
| Facility | | $524.81 | $537.03 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $331.13 / $407.38
| Professional | | $245.47 | $331.13 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $891.25 / $1,862.09
| Facility | | $467.74 | $891.25 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $549.54 / $891.25
| Professional | | $426.58 | $549.54 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $10,471.29 / $25,703.96
| Facility | | $134.90 | $10,471.29 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $389.05 / $416.87
| Professional | | $323.59 | $389.05 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $407.38 / $831.76
| Facility | | $190.55 | $407.38 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $245.47 / $426.58
| Professional | | $162.18 | $245.47 | $426.58 |