- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $6,456.54 / $7,244.36
| Facility | | $3,235.94 | $6,456.54 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $363.08 / $870.96
| Professional | | $316.23 | $363.08 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $912.01
| Facility | | $912.01 | $912.01 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $363.08 / $630.96
| Professional | | $281.84 | $363.08 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $5,011.87
| Facility | | $436.52 | $436.52 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $354.81 / $588.84
| Professional | | $281.84 | $354.81 | $588.84 |