- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $4,897.79 / $7,244.36
| Facility | | $630.96 | $4,897.79 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $426.58 / $758.58
| Professional | | $331.13 | $426.58 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $4,466.84 / $8,317.64
| Facility | | $2,089.30 | $4,466.84 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $398.11 / $691.83
| Professional | | $275.42 | $398.11 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $416.87 / $467.74
| Facility | | $380.19 | $416.87 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $478.63 / $776.25
| Professional | | $371.54 | $478.63 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $2,137.96 / $5,754.40
| Facility | | $199.53 | $2,137.96 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $398.11 / $691.83
| Professional | | $309.03 | $398.11 | $691.83 |