- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $2,290.87 / $4,365.16
| Facility | | $295.12 | $2,290.87 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $295.12 / $316.23
| Professional | | $239.88 | $295.12 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $407.38 / $758.58
| Facility | | $123.03 | $407.38 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $446.68 / $2,238.72
| Professional | | $295.12 | $446.68 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $346.74
| Professional | | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $1,995.26
| Facility | | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $457.09 / $794.33
| Professional | | $309.03 | $457.09 | $794.33 |