- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $2,238.72 / $8,709.64
| Facility | | $426.58 | $2,238.72 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $478.63 / $1,258.93
| Professional | | $251.19 | $478.63 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,128.61 / $12,302.69
| Facility | | $1,659.59 | $5,128.61 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $512.86 / $933.25
| Professional | | $346.74 | $512.86 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,659.59 / $4,168.69
| Facility | | $512.86 | $1,659.59 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $575.44 / $1,174.90
| Professional | | $331.13 | $575.44 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $1,122.02 / $3,467.37
| Facility | | $316.23 | $1,122.02 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $478.63 / $851.14
| Professional | | $288.40 | $478.63 | $851.14 |