- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $3,235.94 / $8,912.51
| Facility | | $501.19 | $3,235.94 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $407.38 / $758.58
| Professional | | $263.03 | $407.38 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,570.88 / $10,232.93
| Facility | | $2,238.72 | $4,570.88 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $416.87 / $758.58
| Professional | | $239.88 | $416.87 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $851.14 / $3,235.94
| Facility | | $363.08 | $851.14 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $512.86 / $1,096.48
| Professional | | $302.00 | $512.86 | $1,096.48 |
- 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
- $263.03 / $426.58 / $794.33
| Professional | | $263.03 | $426.58 | $794.33 |