- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $4,466.84 / $10,232.93
| Facility | | $416.87 | $4,466.84 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $295.12 / $426.58
| Professional | | $213.80 | $295.12 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $6,025.60 / $7,762.47
| Facility | | $3,715.35 | $6,025.60 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $524.81 / $707.95
| Professional | | $407.38 | $524.81 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,691.53 / $2,691.53
| Professional | | $1,698.24 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $3,090.30 / $9,120.11
| Facility | | $1,659.59 | $3,090.30 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $354.81 / $501.19
| Professional | | $257.04 | $354.81 | $501.19 |