- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $7,585.78 / $8,709.64
| Facility | | $1,659.59 | $7,585.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $741.31 / $1,659.59
| Professional | | $524.81 | $741.31 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $512.86 / $35,481.34
| Facility | | $323.59 | $512.86 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $114.82 / $954.99
| Professional | | $114.82 | $114.82 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.62 / $446.68 / $1,348.96
| Facility | | $77.62 | $446.68 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $56.23 / $56.23
| Facility | | $56.23 | $56.23 | $56.23 |