- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $741.31 / $1,659.59
| Facility | | $724.44 | $741.31 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $245.47 / $295.12
| Professional | | $162.18 | $245.47 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $416.87
| Facility | | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,019.95 / $4,677.35
| Facility | | $1,905.46 | $3,019.95 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $295.12 / $549.54
| Professional | | $208.93 | $295.12 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,011.87 / $8,511.38
| Facility | | $2,089.30 | $5,011.87 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $263.03 / $549.54
| Professional | | $186.21 | $263.03 | $549.54 |