- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,071.52 / $2,454.71
| Facility | | $489.78 | $1,071.52 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $269.15 / $436.52
| Professional | | $239.88 | $269.15 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $5,370.32 / $7,244.36
| Facility | | $5,370.32 | $5,370.32 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $275.42 / $363.08
| Professional | | $275.42 | $275.42 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $562.34 / $2,884.03
| Facility | | $512.86 | $562.34 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $338.84 / $478.63
| Professional | | $245.47 | $338.84 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,288.25 / $7,943.28
| Facility | | $562.34 | $1,288.25 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $316.23 / $489.78
| Professional | | $239.88 | $316.23 | $489.78 |