- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,884.03 / $6,456.54
| Facility | | $1,778.28 | $2,884.03 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,513.56 / $3,981.07
| Professional | | $602.56 | $1,513.56 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.03 / $575.44 / $2,818.38
| Facility | | $0.03 | $575.44 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $3,630.78 / $9,772.37
| Facility | | $83.18 | $3,630.78 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.03 / $630.96 / $2,818.38
| Facility | | $0.03 | $630.96 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,819.70 / $2,818.38
| Facility | | $501.19 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $53.70 / $53.70
| Professional | | $53.70 | $53.70 | $53.70 |