- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,454.71 / $6,606.93
| Facility | | $758.58 | $2,454.71 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $588.84 / $758.58
| Professional | | $223.87 | $588.84 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $891.25 / $4,466.84
| Facility | | $501.19 | $891.25 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $741.31 / $1,348.96
| Professional | | $524.81 | $741.31 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,949.84 / $6,165.95
| Facility | | $346.74 | $1,949.84 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $676.08 / $977.24
| Professional | | $501.19 | $676.08 | $977.24 |