- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $3,801.89 / $10,471.29
| Facility | | $478.63 | $3,801.89 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $436.52 / $954.99
| Professional | | $229.09 | $436.52 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,888.44 / $13,489.63
| Facility | | $2,089.30 | $5,888.44 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $478.63 / $954.99
| Professional | | $251.19 | $478.63 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $1,202.26 / $3,467.37
| Facility | | $389.05 | $1,202.26 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $512.86 / $1,096.48
| Professional | | $269.15 | $512.86 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,265.80 / $9,772.37
| Facility | | $1,513.56 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $436.52 / $851.14
| Professional | | $229.09 | $436.52 | $851.14 |