- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $2,754.23 / $4,786.30
| Facility | | $776.25 | $2,754.23 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $549.54 / $630.96
| Professional | | $389.05 | $549.54 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,981.07 / $12,589.25
| Facility | | $2,884.03 | $3,981.07 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $42.66 / $50.12
| Professional | | $38.02 | $42.66 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $9,332.54 / $22,908.68
| Facility | | $1,348.96 | $9,332.54 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $758.58 / $1,584.89
| Professional | | $562.34 | $758.58 | $1,584.89 |