- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $5,623.41 / $10,232.93
| Facility | | $2,238.72 | $5,623.41 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $2,137.96 / $5,754.40
| Professional | | $50.12 | $2,137.96 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $44.67 / $44.67
| Professional | | $30.20 | $44.67 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $407.38 / $870.96
| Facility | | $346.74 | $407.38 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $4,466.84 / $5,128.61
| Facility | | $1,071.52 | $4,466.84 | $5,128.61 |