- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $363.08 / $1,659.59
| Facility | | $354.81 | $363.08 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $223.87 / $275.42
| Professional | | $162.18 | $223.87 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $602.56 / $1,258.93
| Facility | | $316.23 | $602.56 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $363.08 / $602.56
| Professional | | $288.40 | $363.08 | $602.56 |
- 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
- $218.78 / $263.03 / $281.84
| Professional | | $218.78 | $263.03 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $275.42 / $562.34
| Facility | | $128.82 | $275.42 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $165.96 / $288.40
| Professional | | $109.65 | $165.96 | $288.40 |