- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $4,570.88 / $11,481.54
| Facility | | $954.99 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $851.14 / $1,548.82
| Professional | | $549.54 | $851.14 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $7,413.10 / $15,135.61
| Facility | | $2,884.03 | $7,413.10 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $831.76 / $1,778.28
| Professional | | $489.78 | $831.76 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,949.84 / $6,025.60
| Facility | | $398.11 | $1,949.84 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,096.48 / $2,454.71
| Professional | | $588.84 | $1,096.48 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,623.41 / $12,302.69
| Facility | | $1,995.26 | $5,623.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $831.76 / $1,698.24
| Professional | | $537.03 | $831.76 | $1,698.24 |