- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $6,760.83 / $8,709.64
| Facility | | $354.81 | $6,760.83 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $354.81 / $436.52
| Professional | | $275.42 | $354.81 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $724.44 / $954.99
| Professional | | $512.86 | $724.44 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $371.54 / $616.60
| Facility | | $295.12 | $371.54 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $9,549.93 / $14,454.40
| Facility | | $2,754.23 | $9,549.93 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $501.19 / $891.25
| Professional | | $346.74 | $501.19 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,019.95 / $3,019.95
| Professional | | $2,511.89 | $3,019.95 | $3,019.95 |