- 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
- $128.82 / $281.84 / $489.78
| Professional | | $128.82 | $281.84 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $776.25
| Facility | | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $316.23 / $457.09
| Professional | | $151.36 | $316.23 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $371.54 / $2,630.27
| Facility | | $138.04 | $371.54 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $363.08 / $2,290.87
| Professional | | $251.19 | $363.08 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,318.26 / $2,630.27
| Facility | | $371.54 | $1,318.26 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $223.87 / $389.05
| Professional | | $123.03 | $223.87 | $389.05 |