- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $3,548.13 / $9,772.37
| Facility | | $446.68 | $3,548.13 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $416.87 / $831.76
| Professional | | $275.42 | $416.87 | $831.76 |
- 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
- $234.42 / $407.38 / $776.25
| Professional | | $234.42 | $407.38 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,513.56 / $3,235.94
| Facility | | $501.19 | $1,513.56 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $512.86 / $1,096.48
| Professional | | $316.23 | $512.86 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,265.80 / $10,232.93
| Facility | | $1,513.56 | $4,265.80 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $426.58 / $812.83
| Professional | | $269.15 | $426.58 | $812.83 |