- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,677.35 / $10,964.78
| Facility | | $2,041.74 | $4,677.35 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $46.77 / $1,445.44
| Professional | | $46.77 | $46.77 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $102.33 / $776.25
| Facility | | $102.33 | $102.33 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.59 / $7.59 / $7.59
| Professional | | $7.59 | $7.59 | $7.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $933.25 / $2,041.74
| Facility | | $257.04 | $933.25 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,230.27 / $2,187.76
| Facility | | $676.08 | $1,230.27 | $2,187.76 |