- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $3,388.44 / $9,549.93
| Facility | | $870.96 | $3,388.44 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $263.03 / $407.38
| Professional | | $223.87 | $263.03 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,365.16 / $10,232.93
| Facility | | $1,621.81 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $338.84 / $562.34
| Professional | | $218.78 | $338.84 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $691.83 / $2,137.96
| Facility | | $354.81 | $691.83 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $338.84 / $691.83
| Professional | | $229.09 | $338.84 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,981.07 / $9,549.93
| Facility | | $1,023.29 | $3,981.07 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $281.84 / $501.19
| Professional | | $204.17 | $281.84 | $501.19 |