- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,548.82 / $4,365.16
| Facility | | $549.54 | $1,548.82 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $426.58 / $707.95
| Professional | | $281.84 | $426.58 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,265.80 / $6,025.60
| Facility | | $2,290.87 | $4,265.80 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $478.63 / $575.44
| Professional | | $346.74 | $478.63 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $39.81
| Facility | | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $512.86 / $831.76
| Professional | | $269.15 | $512.86 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,630.27 / $6,606.93
| Facility | | $831.76 | $2,630.27 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $436.52 / $707.95
| Professional | | $295.12 | $436.52 | $707.95 |