- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,445.44 / $1,862.09
| Facility | | $575.44 | $1,445.44 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $407.38 / $758.58
| Professional | | $316.23 | $407.38 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $7,762.47 / $10,471.29
| Facility | | $6,456.54 | $7,762.47 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $416.87 / $524.81
| Professional | | $281.84 | $416.87 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $616.60 / $616.60
| Facility | | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $549.54 / $1,230.27
| Professional | | $309.03 | $549.54 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $549.54 / $1,348.96
| Facility | | $251.19 | $549.54 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $380.19 / $741.31
| Professional | | $281.84 | $380.19 | $741.31 |