- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $3,162.28 / $9,332.54
| Facility | | $575.44 | $3,162.28 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $346.74 / $758.58
| Professional | | $263.03 | $346.74 | $758.58 |
- 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 / $363.08 / $707.95
| Professional | | $239.88 | $363.08 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $812.83 / $2,290.87
| Facility | | $295.12 | $812.83 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $446.68 / $977.24
| Professional | | $281.84 | $446.68 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,884.03 / $6,309.57
| Facility | | $1,023.29 | $2,884.03 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $346.74 / $660.69
| Professional | | $239.88 | $346.74 | $660.69 |