- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,398.83 / $6,606.93
| Facility | | $501.19 | $2,398.83 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $354.81 / $602.56
| Professional | | $223.87 | $354.81 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $436.52
| Facility | | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $426.58 / $575.44
| Professional | | $257.04 | $426.58 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $489.78 / $3,235.94
| Facility | | $257.04 | $489.78 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $426.58 / $2,818.38
| Professional | | $316.23 | $426.58 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,949.84 / $3,801.89
| Facility | | $575.44 | $1,949.84 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $316.23 / $467.74
| Professional | | $213.80 | $316.23 | $467.74 |