- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,445.44 / $2,238.72
| Facility | | $776.25 | $1,445.44 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $213.80 / $416.87
| Professional | | $128.82 | $213.80 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $208.93 / $208.93
| Professional | | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $4,786.30 / $6,456.54
| Facility | | $3,981.07 | $4,786.30 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $186.21 / $275.42
| Professional | | $131.83 | $186.21 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $218.78 / $467.74
| Professional | | $134.90 | $218.78 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,737.80 / $3,388.44
| Facility | | $630.96 | $1,737.80 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $181.97 / $309.03
| Professional | | $112.20 | $181.97 | $309.03 |