- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $2,818.38 / $8,912.51
| Facility | | $512.86 | $2,818.38 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $407.38 / $776.25
| Professional | | $295.12 | $407.38 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $3,630.78 / $8,709.64
| Facility | | $1,380.38 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $416.87 / $794.33
| Professional | | $281.84 | $416.87 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $512.86 / $1,659.59
| Facility | | $323.59 | $512.86 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $489.78 / $977.24
| Professional | | $309.03 | $489.78 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $1,023.29 / $3,311.31
| Facility | | $173.78 | $1,023.29 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $426.58 / $758.58
| Professional | | $288.40 | $426.58 | $758.58 |