- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.50 / $484.81 / $3,043.50
| Facility | | $245.50 | $484.81 | $3,043.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.04 / $1,083.45 / $10,435.50
| Professional | | $325.04 | $1,083.45 | $10,435.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $345.60 / $667.01 / $50,842.00
| Facility | | $345.60 | $667.01 | $50,842.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.48 / $796.84 / $5,312.41
| Professional | | $276.48 | $796.84 | $5,312.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.50 / $277.20 / $1,515.54
| Facility | | $192.50 | $277.20 | $1,515.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,115.58 / $1,381.20 / $1,912.43
| Professional | | $1,115.58 | $1,381.20 | $1,912.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.56 / $949.80 / $5,838.74
| Professional | | $314.56 | $949.80 | $5,838.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,786.33 / $2,890.80 / $4,703.02
| Professional | | $1,786.33 | $2,890.80 | $4,703.02 |