- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,398.83 / $6,606.93
| Facility | | $501.19 | $2,398.83 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $309.03 / $537.03
| Professional | | $245.47 | $309.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $416.87 / $537.03
| Professional | | $323.59 | $416.87 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $467.74 / $2,454.71
| Facility | | $223.87 | $467.74 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $446.68 / $2,754.23
| Professional | | $338.84 | $446.68 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $630.96 / $1,659.59
| Facility | | $138.04 | $630.96 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $363.08 / $501.19
| Professional | | $275.42 | $363.08 | $501.19 |