- 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
- $239.88 / $316.23 / $870.96
| Professional | | $239.88 | $316.23 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $6,760.83 / $9,120.11
| Facility | | $5,623.41 | $6,760.83 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $354.81 / $416.87
| Professional | | $245.47 | $354.81 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $331.13 / $831.76
| Professional | | $239.88 | $331.13 | $831.76 |
- 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
- $204.17 / $309.03 / $1,023.29
| Professional | | $204.17 | $309.03 | $1,023.29 |