- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $4,073.80 / $9,332.54
| Facility | | $676.08 | $4,073.80 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $446.68 / $1,905.46
| Professional | | $95.50 | $446.68 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $512.86 / $35,481.34
| Facility | | $323.59 | $512.86 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $114.82 / $147.91
| Professional | | $114.82 | $114.82 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $3,630.78
| Facility | | $3,630.78 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.62 / $446.68 / $1,348.96
| Facility | | $77.62 | $446.68 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $56.23 / $56.23
| Facility | | $56.23 | $56.23 | $56.23 |