- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $3,311.31 / $9,332.54
| Facility | | $575.44 | $3,311.31 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $457.09 / $870.96
| Professional | | $323.59 | $457.09 | $870.96 |
- 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
- $323.59 / $467.74 / $870.96
| Professional | | $323.59 | $467.74 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,445.44 / $4,466.84
| Facility | | $549.54 | $1,445.44 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $524.81 / $1,071.52
| Professional | | $338.84 | $524.81 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $4,168.69 / $10,471.29
| Facility | | $1,047.13 | $4,168.69 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $467.74 / $831.76
| Professional | | $309.03 | $467.74 | $831.76 |