- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $3,019.95 / $8,709.64
| Facility | | $436.52 | $3,019.95 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $380.19 / $831.76
| Professional | | $239.88 | $380.19 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,365.16 / $9,549.93
| Facility | | $1,584.89 | $4,365.16 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $407.38 / $812.83
| Professional | | $263.03 | $407.38 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $1,513.56 / $3,801.89
| Facility | | $478.63 | $1,513.56 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $478.63 / $1,047.13
| Professional | | $288.40 | $478.63 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $1,202.26 / $3,548.13
| Facility | | $316.23 | $1,202.26 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $398.11 / $758.58
| Professional | | $245.47 | $398.11 | $758.58 |