- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $4,677.35 / $10,471.29
| Facility | | $354.81 | $4,677.35 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $281.84 / $602.56
| Professional | | $162.18 | $281.84 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,162.28 / $10,471.29
| Facility | | $2,137.96 | $3,162.28 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $371.54 / $524.81
| Professional | | $218.78 | $371.54 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $389.05
| Facility | | $50.12 | $50.12 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $389.05 / $776.25
| Professional | | $257.04 | $389.05 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $436.52 / $758.58
| Professional | | $354.81 | $436.52 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,467.37 / $6,760.83
| Facility | | $1,288.25 | $3,467.37 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $346.74 / $724.44
| Professional | | $186.21 | $346.74 | $724.44 |