- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $3,162.28 / $4,570.88
| Facility | | $323.59 | $3,162.28 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $346.74 / $676.08
| Professional | | $302.00 | $346.74 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $457.09 / $575.44
| Professional | | $251.19 | $457.09 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $602.56
| Professional | | $32.36 | $33.11 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $512.86 / $1,122.02
| Facility | | $436.52 | $512.86 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $537.03 / $691.83
| Professional | | $426.58 | $537.03 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $512.86 / $660.69
| Professional | | $323.59 | $512.86 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $416.87 / $588.84
| Professional | | $186.21 | $416.87 | $588.84 |
- 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
- $263.03 / $323.59 / $512.86
| Professional | | $263.03 | $323.59 | $512.86 |