- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $3,388.44 / $9,120.11
| Facility | | $549.54 | $3,388.44 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $457.09 / $1,096.48
| Professional | | $281.84 | $457.09 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,754.40 / $13,489.63
| Facility | | $1,995.26 | $5,754.40 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $467.74 / $954.99
| Professional | | $281.84 | $467.74 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,445.44 / $3,890.45
| Facility | | $436.52 | $1,445.44 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $562.34 / $1,258.93
| Professional | | $323.59 | $562.34 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,265.80 / $9,772.37
| Facility | | $1,584.89 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $457.09 / $870.96
| Professional | | $281.84 | $457.09 | $870.96 |