- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $1,949.84 / $4,570.88
| Facility | | $446.68 | $1,949.84 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $257.04 / $407.38
| Professional | | $194.98 | $257.04 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $158.49 / $338.84
| Professional | | $158.49 | $158.49 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,467.37 / $5,754.40
| Facility | | $1,621.81 | $3,467.37 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $331.13 / $426.58
| Professional | | $234.42 | $331.13 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $1,445.44 / $1,445.44
| Facility | | $39.81 | $1,445.44 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $295.12 / $416.87
| Professional | | $190.55 | $295.12 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,479.11 / $4,365.16
| Facility | | $467.74 | $1,479.11 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $257.04 / $426.58
| Professional | | $190.55 | $257.04 | $426.58 |