- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $5,248.07 / $5,248.07
| Facility | | $239.88 | $5,248.07 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $346.74 / $549.54
| Professional | | $223.87 | $346.74 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $263.03 / $316.23
| Facility | | $263.03 | $263.03 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $281.84 / $281.84
| Professional | | $281.84 | $281.84 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $1,862.09
| Facility | | $426.58 | $426.58 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $407.38 / $2,754.23
| Professional | | $245.47 | $407.38 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $9,120.11
| Facility | | $2,454.71 | $2,454.71 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $338.84 / $537.03
| Professional | | $208.93 | $338.84 | $537.03 |