- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,659.59 / $5,370.32
| Facility | | $660.69 | $1,659.59 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $524.81 / $870.96
| Professional | | $257.04 | $524.81 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $257.04 / $380.19
| Professional | | $245.47 | $257.04 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,248.07 / $7,585.78
| Facility | | $2,884.03 | $5,248.07 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $512.86 / $954.99
| Professional | | $309.03 | $512.86 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $39.81
| Facility | | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $446.68 / $912.01
| Professional | | $281.84 | $446.68 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,630.27 / $6,606.93
| Facility | | $831.76 | $2,630.27 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $501.19 / $1,202.26
| Professional | | $245.47 | $501.19 | $1,202.26 |