- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $3,090.30 / $9,120.11
| Facility | | $645.65 | $3,090.30 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $467.74 / $1,096.48
| Professional | | $380.19 | $467.74 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,630.78 / $8,709.64
| Facility | | $1,445.44 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $524.81 / $1,047.13
| Professional | | $346.74 | $524.81 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $1,318.26 / $3,388.44
| Facility | | $251.19 | $1,318.26 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $616.60 / $1,412.54
| Professional | | $407.38 | $616.60 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $1,071.52 / $3,467.37
| Facility | | $204.17 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $478.63 / $912.01
| Professional | | $338.84 | $478.63 | $912.01 |