- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,513.56 / $2,454.71
| Facility | | $776.25 | $1,513.56 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $691.83 / $977.24
| Professional | | $602.56 | $691.83 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $6,760.83 / $9,120.11
| Facility | | $6,760.83 | $6,760.83 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $954.99
| Professional | | $707.95 | $707.95 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $3,235.94
| Facility | | $3,235.94 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $977.24 / $1,122.02
| Professional | | $489.78 | $977.24 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,951.21 / $11,220.18
| Facility | | $1,230.27 | $2,951.21 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $812.83 / $1,202.26
| Professional | | $588.84 | $812.83 | $1,202.26 |