- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $3,235.94 / $10,471.29
| Facility | | $416.87 | $3,235.94 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $407.38 / $812.83
| Professional | | $323.59 | $407.38 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,890.45 / $9,549.93
| Facility | | $1,698.24 | $3,890.45 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $446.68 / $831.76
| Professional | | $295.12 | $446.68 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $616.60 / $3,019.95
| Facility | | $169.82 | $616.60 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $524.81 / $1,148.15
| Professional | | $346.74 | $524.81 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $1,071.52 / $3,388.44
| Facility | | $223.87 | $1,071.52 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $416.87 / $794.33
| Professional | | $295.12 | $416.87 | $794.33 |