- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $3,388.44 / $9,120.11
| Facility | | $660.69 | $3,388.44 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $537.03 / $1,096.48
| Professional | | $354.81 | $537.03 | $1,096.48 |
- 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
- $380.19 / $588.84 / $1,148.15
| Professional | | $380.19 | $588.84 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,819.70 / $5,370.32
| Facility | | $562.34 | $1,819.70 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $691.83 / $1,479.11
| Professional | | $426.58 | $691.83 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,122.02 / $3,467.37
| Facility | | $302.00 | $1,122.02 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $562.34 / $1,071.52
| Professional | | $354.81 | $562.34 | $1,071.52 |