- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $3,548.13 / $8,912.51
| Facility | | $489.78 | $3,548.13 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $288.40 / $812.83
| Professional | | $229.09 | $288.40 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,623.41 / $13,489.63
| Facility | | $1,995.26 | $5,623.41 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $354.81 / $645.65
| Professional | | $229.09 | $354.81 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $776.25 / $2,137.96
| Facility | | $398.11 | $776.25 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $398.11 / $831.76
| Professional | | $251.19 | $398.11 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,365.16 / $10,232.93
| Facility | | $1,584.89 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $309.03 / $575.44
| Professional | | $213.80 | $309.03 | $575.44 |