- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $3,311.31 / $9,120.11
| Facility | | $562.34 | $3,311.31 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $426.58 / $794.33
| Professional | | $281.84 | $426.58 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,365.16 / $10,232.93
| Facility | | $1,621.81 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $426.58 / $794.33
| Professional | | $239.88 | $426.58 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $588.84 / $3,388.44
| Facility | | $309.03 | $588.84 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $537.03 / $1,148.15
| Professional | | $323.59 | $537.03 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $4,073.80 / $9,549.93
| Facility | | $1,348.96 | $4,073.80 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $446.68 / $831.76
| Professional | | $281.84 | $446.68 | $831.76 |