- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $346.74 / $562.34
| Facility | | $295.12 | $346.74 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $346.74 / $478.63
| Professional | | $295.12 | $346.74 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $4,786.30 / $6,309.57
| Facility | | $549.54 | $4,786.30 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $549.54 / $912.01
| Professional | | $398.11 | $549.54 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50,118.72 / $50,118.72 / $53,703.18
| Facility | | $50,118.72 | $50,118.72 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $371.54 / $371.54
| Professional | | $302.00 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $741.31 / $758.58
| Professional | | $524.81 | $741.31 | $758.58 |