- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,454.71 / $6,606.93
| Facility | | $758.58 | $2,454.71 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $457.09 / $758.58
| Professional | | $389.05 | $457.09 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $7,943.28 / $13,182.57
| Facility | | $5,128.61 | $7,943.28 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $549.54 / $630.96
| Professional | | $416.87 | $549.54 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $1,445.44 / $5,128.61
| Facility | | $457.09 | $1,445.44 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $489.78 / $6,165.95
| Professional | | $363.08 | $489.78 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $2,089.30 / $4,073.80
| Facility | | $575.44 | $2,089.30 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $436.52 / $630.96
| Professional | | $338.84 | $436.52 | $630.96 |