- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $478.63 / $2,187.76
| Facility | | $467.74 | $478.63 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $295.12 / $363.08
| Professional | | $213.80 | $295.12 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $794.33 / $794.33
| Facility | | $354.81 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $478.63 / $776.25
| Professional | | $380.19 | $478.63 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $11,481.54 / $25,703.96
| Facility | | $134.90 | $11,481.54 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $251.19 / $251.19
| Professional | | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $363.08 / $758.58
| Facility | | $218.78 | $363.08 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $218.78 / $380.19
| Professional | | $144.54 | $218.78 | $380.19 |