- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $3,801.89 / $5,623.41
| Facility | | $275.42 | $3,801.89 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $288.40 / $512.86
| Professional | | $199.53 | $288.40 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,466.84 / $8,709.64
| Facility | | $2,454.71 | $4,466.84 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $204.17 / $346.74
| Professional | | $173.78 | $204.17 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $208.93 / $208.93
| Facility | | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $346.74 / $446.68
| Facility | | $186.21 | $346.74 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $288.40 / $467.74
| Professional | | $213.80 | $288.40 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $2,818.38 / $4,265.80
| Facility | | $457.09 | $2,818.38 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $281.84 / $457.09
| Professional | | $204.17 | $281.84 | $457.09 |