- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $3,235.94 / $9,332.54
| Facility | | $562.34 | $3,235.94 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $436.52 / $1,096.48
| Professional | | $309.03 | $436.52 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,248.07 / $11,220.18
| Facility | | $2,089.30 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $436.52 / $831.76
| Professional | | $288.40 | $436.52 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $954.99 / $2,454.71
| Facility | | $446.68 | $954.99 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $501.19 / $1,047.13
| Professional | | $338.84 | $501.19 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $2,041.74 / $4,897.79
| Facility | | $660.69 | $2,041.74 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $407.38 / $741.31
| Professional | | $281.84 | $407.38 | $741.31 |