- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,235.94 / $9,120.11
| Facility | | $398.11 | $3,235.94 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $346.74 / $758.58
| Professional | | $234.42 | $346.74 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $5,011.87 / $10,964.78
| Facility | | $1,737.80 | $5,011.87 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $346.74 / $630.96
| Professional | | $234.42 | $346.74 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $1,202.26 / $2,570.40
| Facility | | $407.38 | $1,202.26 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $389.05 / $812.83
| Professional | | $251.19 | $389.05 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,691.53 / $6,606.93
| Facility | | $645.65 | $2,691.53 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $331.13 / $616.60
| Professional | | $223.87 | $331.13 | $616.60 |