- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $2,884.03 / $8,912.51
| Facility | | $512.86 | $2,884.03 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $446.68 / $794.33
| Professional | | $295.12 | $446.68 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $5,495.41 / $12,022.64
| Facility | | $2,187.76 | $5,495.41 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $416.87 / $794.33
| Professional | | $269.15 | $416.87 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $524.81 / $1,737.80
| Facility | | $323.59 | $524.81 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $478.63 / $1,047.13
| Professional | | $302.00 | $478.63 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,981.07 / $9,549.93
| Facility | | $1,047.13 | $3,981.07 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $416.87 / $776.25
| Professional | | $269.15 | $416.87 | $776.25 |