- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,445.44 / $2,398.83
| Facility | | $575.44 | $1,445.44 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $630.96 / $912.01
| Professional | | $537.03 | $630.96 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $7,585.78 / $10,232.93
| Facility | | $6,456.54 | $7,585.78 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $389.05 / $478.63
| Professional | | $269.15 | $389.05 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,801.89 / $11,748.98
| Facility | | $1,023.29 | $3,801.89 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $794.33 / $1,318.26
| Professional | | $436.52 | $794.33 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,467.37 / $6,309.57
| Facility | | $1,096.48 | $3,467.37 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $295.12 / $602.56
| Professional | | $223.87 | $295.12 | $602.56 |