- 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
- $269.15 / $323.59 / $616.60
| Professional | | $269.15 | $323.59 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $169.82 / $169.82
| Facility | | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $389.05 / $851.14
| Professional | | $234.42 | $389.05 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $851.14 / $6,918.31
| Facility | | $275.42 | $851.14 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $389.05 / $3,548.13
| Professional | | $257.04 | $389.05 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,073.80 / $8,317.64
| Facility | | $1,230.27 | $4,073.80 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $309.03 / $588.84
| Professional | | $229.09 | $309.03 | $588.84 |