- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $3,715.35 / $10,232.93
| Facility | | $602.56 | $3,715.35 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $512.86 / $1,071.52
| Professional | | $346.74 | $512.86 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,128.61 / $12,302.69
| Facility | | $1,659.59 | $5,128.61 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $562.34 / $1,071.52
| Professional | | $363.08 | $562.34 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $1,380.38 / $3,890.45
| Facility | | $457.09 | $1,380.38 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $575.44 / $1,318.26
| Professional | | $363.08 | $575.44 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $1,148.15 / $3,467.37
| Facility | | $316.23 | $1,148.15 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $501.19 / $954.99
| Professional | | $323.59 | $501.19 | $954.99 |