- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $3,311.31 / $9,332.54
| Facility | | $501.19 | $3,311.31 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $416.87 / $933.25
| Professional | | $269.15 | $416.87 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,248.07 / $10,964.78
| Facility | | $2,089.30 | $5,248.07 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $426.58 / $776.25
| Professional | | $229.09 | $426.58 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $954.99 / $3,235.94
| Facility | | $446.68 | $954.99 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $512.86 / $1,096.48
| Professional | | $309.03 | $512.86 | $1,096.48 |
- 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
- $269.15 / $426.58 / $812.83
| Professional | | $269.15 | $426.58 | $812.83 |