- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,071.52 / $2,454.71
| Facility | | $575.44 | $1,071.52 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $128.82 / $190.55
| Professional | | $112.20 | $128.82 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,412.54 / $1,949.84
| Facility | | $1,412.54 | $1,412.54 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $562.34 / $1,737.80
| Facility | | $512.86 | $562.34 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $162.18 / $229.09
| Professional | | $114.82 | $162.18 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,288.25 / $4,365.16
| Facility | | $537.03 | $1,288.25 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $141.25 / $223.87
| Professional | | $107.15 | $141.25 | $223.87 |