- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $3,388.44 / $9,549.93
| Facility | | $912.01 | $3,388.44 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $331.13 / $478.63
| Professional | | $275.42 | $331.13 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,715.35 / $9,332.54
| Facility | | $1,548.82 | $3,715.35 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $446.68 / $794.33
| Professional | | $114.82 | $446.68 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $575.44 / $691.83
| Facility | | $389.05 | $575.44 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $537.03 / $977.24
| Professional | | $316.23 | $537.03 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,949.84 / $4,786.30
| Facility | | $575.44 | $1,949.84 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $478.63 / $831.76
| Professional | | $288.40 | $478.63 | $831.76 |