- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,570.40 / $6,606.93
| Facility | | $794.33 | $2,570.40 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $426.58 / $676.08
| Professional | | $281.84 | $426.58 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $5,754.40 / $9,332.54
| Facility | | $3,715.35 | $5,754.40 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $457.09 / $707.95
| Professional | | $323.59 | $457.09 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $602.56 / $4,786.30
| Facility | | $331.13 | $602.56 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $524.81 / $3,890.45
| Professional | | $416.87 | $524.81 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,311.31 / $6,025.60
| Facility | | $891.25 | $3,311.31 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $407.38 / $575.44
| Professional | | $281.84 | $407.38 | $575.44 |