- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $3,235.94 / $9,120.11
| Facility | | $446.68 | $3,235.94 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $363.08 / $707.95
| Professional | | $257.04 | $363.08 | $707.95 |
- 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
- $257.04 / $380.19 / $691.83
| Professional | | $257.04 | $380.19 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $1,174.90 / $2,691.53
| Facility | | $446.68 | $1,174.90 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $426.58 / $851.14
| Professional | | $275.42 | $426.58 | $851.14 |
- 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
- $245.47 / $363.08 / $660.69
| Professional | | $245.47 | $363.08 | $660.69 |