- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $3,311.31 / $9,120.11
| Facility | | $467.74 | $3,311.31 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $363.08 / $741.31
| Professional | | $234.42 | $363.08 | $741.31 |
- 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
- $204.17 / $363.08 / $676.08
| Professional | | $204.17 | $363.08 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $758.58 / $2,884.03
| Facility | | $316.23 | $758.58 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $457.09 / $977.24
| Professional | | $275.42 | $457.09 | $977.24 |
- 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
- $234.42 / $380.19 / $724.44
| Professional | | $234.42 | $380.19 | $724.44 |