- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,513.56 / $4,168.69
| Facility | | $676.08 | $1,513.56 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $2,570.40 / $19,054.61
| Professional | | $489.78 | $2,570.40 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $489.78 / $977.24
| Facility | | $239.88 | $489.78 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $2,754.23
| Facility | | $2,754.23 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $398.11
| Facility | | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Professional | | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $501.19 / $1,202.26
| Facility | | $190.55 | $501.19 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $380.19 / $389.05
| Professional | | $380.19 | $380.19 | $389.05 |