- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $3,162.28 / $4,570.88
| Facility | | $537.03 | $3,162.28 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $436.52 / $1,096.48
| Professional | | $380.19 | $436.52 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $524.81 / $851.14
| Professional | | $346.74 | $524.81 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $60.26
| Professional | | $32.36 | $33.11 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $407.38 / $870.96
| Facility | | $346.74 | $407.38 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $660.69 / $870.96
| Professional | | $524.81 | $660.69 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $758.58 / $912.01
| Professional | | $354.81 | $758.58 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $602.56 / $831.76
| Professional | | $457.09 | $602.56 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $4,466.84 / $5,128.61
| Facility | | $1,071.52 | $4,466.84 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $446.68 / $707.95
| Professional | | $346.74 | $446.68 | $707.95 |