- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,412.54 / $2,041.74
| Facility | | $812.83 | $1,412.54 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $630.96 / $977.24
| Professional | | $562.34 | $630.96 | $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
- $660.69 / $660.69 / $870.96
| Professional | | $660.69 | $660.69 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,187.76
| Facility | | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $912.01 / $1,096.48
| Professional | | $512.86 | $912.01 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,137.96 / $9,549.93
| Facility | | $977.24 | $2,137.96 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $724.44 / $1,148.15
| Professional | | $575.44 | $724.44 | $1,148.15 |