- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $4,677.35 / $11,481.54
| Facility | | $954.99 | $4,677.35 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $467.74 / $1,174.90
| Professional | | $398.11 | $467.74 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $7,413.10 / $15,135.61
| Facility | | $2,754.23 | $7,413.10 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $575.44 / $1,122.02
| Professional | | $398.11 | $575.44 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,621.81 / $10,232.93
| Facility | | $707.95 | $1,621.81 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $660.69 / $1,445.44
| Professional | | $436.52 | $660.69 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,623.41 / $12,302.69
| Facility | | $1,949.84 | $5,623.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $524.81 / $977.24
| Professional | | $371.54 | $524.81 | $977.24 |