- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,445.44 / $2,238.72
| Facility | | $758.58 | $1,445.44 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $426.58 / $794.33
| Professional | | $281.84 | $426.58 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $4,570.88 / $6,309.57
| Facility | | $3,890.45 | $4,570.88 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $426.58 / $588.84
| Professional | | $316.23 | $426.58 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $457.09 / $933.25
| Professional | | $288.40 | $457.09 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $4,365.16 / $6,918.31
| Facility | | $1,479.11 | $4,365.16 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $389.05 / $660.69
| Professional | | $245.47 | $389.05 | $660.69 |