- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $7,079.46 / $7,762.47
| Facility | | $380.19 | $7,079.46 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $398.11 / $794.33
| Professional | | $316.23 | $398.11 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $478.63
| Facility | | $398.11 | $398.11 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $426.58
| Professional | | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $630.96 / $1,862.09
| Facility | | $630.96 | $630.96 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $501.19 / $2,238.72
| Professional | | $316.23 | $501.19 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $8,317.64 / $20,417.38
| Facility | | $4,570.88 | $8,317.64 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $4,466.84 / $16,982.44
| Facility | | $4,466.84 | $4,466.84 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $398.11 / $616.60
| Professional | | $288.40 | $398.11 | $616.60 |