- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,659.59 / $2,454.71
| Facility | | $870.96 | $1,659.59 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $758.58 / $1,348.96
| Professional | | $446.68 | $758.58 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $5,370.32 / $7,244.36
| Facility | | $5,370.32 | $5,370.32 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $1,071.52
| Professional | | $812.83 | $812.83 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $537.03 / $562.34
| Facility | | $512.86 | $537.03 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,570.40 / $11,220.18
| Facility | | $1,230.27 | $2,570.40 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $602.56 / $1,288.25
| Professional | | $257.04 | $602.56 | $1,288.25 |