- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.11 / $376.69 / $452.03
| Facility | | $247.11 | $376.69 | $452.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.01 / $247.11 / $256.14
| Professional | | $226.01 | $247.11 | $256.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $406.82 / $1,695.10 / $8,136.46
| Facility | | $406.82 | $1,695.10 | $8,136.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.62 / $406.82 / $119,998.80
| Professional | | $361.62 | $406.82 | $119,998.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.85 / $361.62 / $903.99
| Facility | | $244.85 | $361.62 | $903.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,452.51 / $1,452.51 / $1,452.51
| Professional | | $1,452.51 | $1,452.51 | $1,452.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.57 / $150.68 / $482.16
| Professional | | $126.57 | $150.68 | $482.16 |