- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $2,818.38 / $8,709.64
| Facility | | $457.09 | $2,818.38 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $338.84 / $707.95
| Professional | | $269.15 | $338.84 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,630.78 / $8,709.64
| Facility | | $1,445.44 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $346.74 / $707.95
| Professional | | $199.53 | $346.74 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $1,047.13 / $2,630.27
| Facility | | $251.19 | $1,047.13 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $436.52 / $977.24
| Professional | | $288.40 | $436.52 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $1,071.52 / $3,467.37
| Facility | | $204.17 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $346.74 / $691.83
| Professional | | $245.47 | $346.74 | $691.83 |