- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $445.50 / $2,683.70 / $5,971.36
| Facility | | $445.50 | $2,683.70 | $5,971.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.22 / $318.22 / $3,268.76
| Professional | | $318.22 | $318.22 | $3,268.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.58 / $814.58 / $814.58
| Facility | | $814.58 | $814.58 | $814.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.96 / $60.64 / $160.14
| Professional | | $43.96 | $60.64 | $160.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.00 / $64.00 / $64.00
| Facility | | $64.00 | $64.00 | $64.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.84 / $673.84 / $673.84
| Professional | | $673.84 | $673.84 | $673.84 |