- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $3,235.94 / $8,709.64
| Facility | | $467.74 | $3,235.94 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $426.58 / $1,071.52
| Professional | | $269.15 | $426.58 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,011.87 / $10,964.78
| Facility | | $1,819.70 | $5,011.87 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $478.63 / $912.01
| Professional | | $295.12 | $478.63 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,148.15 / $3,467.37
| Facility | | $416.87 | $1,148.15 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $575.44 / $1,258.93
| Professional | | $323.59 | $575.44 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $4,168.69 / $9,549.93
| Facility | | $1,348.96 | $4,168.69 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $467.74 / $912.01
| Professional | | $275.42 | $467.74 | $912.01 |