- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $4,897.79 / $11,220.18
| Facility | | $933.25 | $4,897.79 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $588.84 / $912.01
| Professional | | $512.86 | $588.84 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $8,317.64 / $10,471.29
| Facility | | $3,715.35 | $8,317.64 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $588.84 / $933.25
| Professional | | $457.09 | $588.84 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $630.96 / $645.65
| Facility | | $630.96 | $630.96 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $831.76 / $1,071.52
| Facility | | $602.56 | $831.76 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $660.69 / $977.24
| Professional | | $234.42 | $660.69 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $6,025.60 / $10,715.19
| Facility | | $1,348.96 | $6,025.60 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $588.84 / $954.99
| Professional | | $446.68 | $588.84 | $954.99 |