- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $2,691.53 / $6,760.83
| Facility | | $524.81 | $2,691.53 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $416.87 / $562.34
| Professional | | $316.23 | $416.87 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,466.84 / $6,165.95
| Facility | | $2,454.71 | $4,466.84 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $407.38 / $478.63
| Professional | | $338.84 | $407.38 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $39.81
| Facility | | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $467.74 / $660.69
| Professional | | $295.12 | $467.74 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,630.27 / $6,606.93
| Facility | | $831.76 | $2,630.27 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $457.09 / $758.58
| Professional | | $346.74 | $457.09 | $758.58 |