- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $3,801.89 / $10,232.93
| Facility | | $489.78 | $3,801.89 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $407.38 / $812.83
| Professional | | $251.19 | $407.38 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $6,025.60 / $12,302.69
| Facility | | $2,041.74 | $6,025.60 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $389.05 / $741.31
| Professional | | $218.78 | $389.05 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,348.96 / $3,162.28
| Facility | | $467.74 | $1,348.96 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $489.78 / $1,071.52
| Professional | | $288.40 | $489.78 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $4,073.80 / $9,549.93
| Facility | | $1,318.26 | $4,073.80 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $407.38 / $776.25
| Professional | | $251.19 | $407.38 | $776.25 |