- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $2,884.03 / $3,890.45
| Facility | | $478.63 | $2,884.03 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $316.23 / $602.56
| Professional | | $234.42 | $316.23 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $691.83 / $724.44
| Facility | | $562.34 | $691.83 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $691.83 / $1,445.44
| Professional | | $30.20 | $691.83 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $346.74 / $758.58
| Facility | | $295.12 | $346.74 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $588.84 / $1,258.93
| Professional | | $537.03 | $588.84 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $512.86
| Professional | | $512.86 | $512.86 | $512.86 |