- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,071.52 / $2,041.74
| Facility | | $416.87 | $1,071.52 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $616.60 / $831.76
| Professional | | $407.38 | $616.60 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $5,370.32 / $7,413.10
| Facility | | $5,370.32 | $5,370.32 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $630.96 / $1,023.29
| Professional | | $478.63 | $630.96 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $1,737.80
| Facility | | $1,737.80 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $691.83 / $1,096.48
| Professional | | $346.74 | $691.83 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,445.44 / $7,762.47
| Facility | | $588.84 | $1,445.44 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $630.96 / $1,071.52
| Professional | | $363.08 | $630.96 | $1,071.52 |