- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,570.40 / $5,888.44
| Facility | | $891.25 | $2,570.40 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $363.08 / $794.33
| Professional | | $281.84 | $363.08 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,019.95 / $7,079.46
| Facility | | $1,479.11 | $3,019.95 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $416.87 / $512.86
| Professional | | $323.59 | $416.87 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $1,318.26 / $1,318.26
| Facility | | $39.81 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $416.87 / $575.44
| Professional | | $257.04 | $416.87 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,479.11 / $3,981.07
| Facility | | $467.74 | $1,479.11 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $331.13 / $562.34
| Professional | | $263.03 | $331.13 | $562.34 |