- 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
- $302.00 / $407.38 / $660.69
| Professional | | $302.00 | $407.38 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,715.35 / $5,011.87
| Facility | | $3,090.30 | $3,715.35 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $645.65 / $912.01
| Professional | | $512.86 | $645.65 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $467.74 / $912.01
| Professional | | $346.74 | $467.74 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,951.21 / $4,265.80
| Facility | | $831.76 | $2,951.21 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $371.54 / $588.84
| Professional | | $281.84 | $371.54 | $588.84 |