- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $380.19 / $812.83
| Facility | | $316.23 | $380.19 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $407.38 / $691.83
| Professional | | $309.03 | $407.38 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $7,244.36 / $12,882.50
| Facility | | $2,344.23 | $7,244.36 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $758.58 / $1,819.70
| Professional | | $436.52 | $758.58 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $537.03 / $53,703.18
| Facility | | $363.08 | $537.03 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $660.69 / $933.25
| Professional | | $467.74 | $660.69 | $933.25 |