- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $2,630.27 / $6,760.83
| Facility | | $575.44 | $2,630.27 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $512.86 / $794.33
| Professional | | $446.68 | $512.86 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $5,754.40 / $9,332.54
| Facility | | $3,630.78 | $5,754.40 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $645.65 / $831.76
| Professional | | $501.19 | $645.65 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $691.83 / $3,981.07
| Facility | | $512.86 | $691.83 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $602.56 / $4,365.16
| Professional | | $489.78 | $602.56 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,995.26 / $3,981.07
| Facility | | $575.44 | $1,995.26 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $524.81 / $724.44
| Professional | | $426.58 | $524.81 | $724.44 |