- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.24 / $1,157.44 / $2,723.04
| Facility | | $825.24 | $1,157.44 | $2,723.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.93 / $507.78 / $910.21
| Professional | | $129.93 | $507.78 | $910.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $551.42 / $8,275.50 / $14,220.62
| Facility | | $551.42 | $8,275.50 | $14,220.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $290.18 / $2,736.98 / $3,087.43
| Facility | | $290.18 | $2,736.98 | $3,087.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.34 / $489.34 / $489.34
| Professional | | $489.34 | $489.34 | $489.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.08 / $1,760.35 / $3,409.06
| Facility | | $1,550.08 | $1,760.35 | $3,409.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.00 / $80.00 / $80.00
| Professional | | $68.00 | $80.00 | $80.00 |