- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $591.01 / $1,247.03 / $5,461.58
| Facility | | $591.01 | $1,247.03 | $5,461.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.14 / $438.83 / $591.01
| Professional | | $191.14 | $438.83 | $591.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $713.79 / $713.79 / $839.45
| Facility | | $713.79 | $713.79 | $839.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.42 / $883.92 / $1,445.17
| Professional | | $113.42 | $883.92 | $1,445.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.81 / $128.81 / $709.21
| Professional | | $128.81 | $128.81 | $709.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.00 / $350.00 / $350.00
| Professional | | $350.00 | $350.00 | $350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.16 / $1,099.05 / $1,772.62
| Professional | | $144.16 | $1,099.05 | $1,772.62 |