- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $936.49 / $1,427.58 / $1,713.09
| Facility | | $936.49 | $1,427.58 | $1,713.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $856.55 / $936.49 / $970.75
| Professional | | $856.55 | $936.49 | $970.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,541.78 / $6,424.09 / $30,835.62
| Facility | | $1,541.78 | $6,424.09 | $30,835.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,370.47 / $1,541.78 / $119,998.80
| Professional | | $1,370.47 | $1,541.78 | $119,998.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $927.93 / $1,113.51 / $1,370.47
| Facility | | $927.93 | $1,113.51 | $1,370.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,504.73 / $5,504.73 / $5,504.73
| Professional | | $5,504.73 | $5,504.73 | $5,504.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $479.67 / $571.03 / $1,655.99
| Professional | | $479.67 | $571.03 | $1,655.99 |