- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.34 / $2,317.86 / $3,038.88
| Facility | | $442.34 | $2,317.86 | $3,038.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.58 / $296.67 / $442.34
| Professional | | $264.58 | $296.67 | $442.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $305.62 / $314.33 / $985.19
| Facility | | $305.62 | $314.33 | $985.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.17 / $410.94 / $513.66
| Professional | | $225.17 | $410.94 | $513.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $357.56 / $411.19 / $1,609.02
| Facility | | $357.56 | $411.19 | $1,609.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.69 / $291.39 / $412.17
| Professional | | $273.69 | $291.39 | $412.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.18 / $206.43 / $214.54
| Professional | | $150.18 | $206.43 | $214.54 |