- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $1,258.93 / $2,570.40
| Facility | | $234.42 | $1,258.93 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $346.74 / $741.31
| Professional | | $234.42 | $346.74 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $257.04 / $281.84
| Professional | | $117.49 | $257.04 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,884.03 / $3,890.45
| Facility | | $2,454.71 | $2,884.03 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $234.42 / $295.12
| Professional | | $144.54 | $234.42 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $275.42 / $630.96
| Professional | | $199.53 | $275.42 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,737.80 / $3,090.30
| Facility | | $645.65 | $1,737.80 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $245.47 / $323.59
| Professional | | $190.55 | $245.47 | $323.59 |