- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,570.40 / $6,606.93
| Facility | | $794.33 | $2,570.40 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $457.09 / $676.08
| Professional | | $371.54 | $457.09 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $1,258.93
| Facility | | $1,258.93 | $1,258.93 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $501.19 / $645.65
| Professional | | $354.81 | $501.19 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $616.60 / $4,265.80
| Facility | | $416.87 | $616.60 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $467.74 / $3,388.44
| Professional | | $380.19 | $467.74 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,949.84 / $3,981.07
| Facility | | $575.44 | $1,949.84 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $416.87 / $537.03
| Professional | | $331.13 | $416.87 | $537.03 |