- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $3,311.31 / $9,332.54
| Facility | | $537.03 | $3,311.31 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $426.58 / $794.33
| Professional | | $281.84 | $426.58 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,165.95 / $14,125.38
| Facility | | $2,290.87 | $6,165.95 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $426.58 / $812.83
| Professional | | $288.40 | $426.58 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,412.54 / $4,265.80
| Facility | | $489.78 | $1,412.54 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $489.78 / $1,023.29
| Professional | | $309.03 | $489.78 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $6,456.54 / $15,848.93
| Facility | | $1,737.80 | $6,456.54 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $426.58 / $776.25
| Professional | | $275.42 | $426.58 | $776.25 |