- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $3,981.07 / $10,715.19
| Facility | | $457.09 | $3,981.07 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $398.11 / $812.83
| Professional | | $275.42 | $398.11 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $6,025.60 / $12,302.69
| Facility | | $1,905.46 | $6,025.60 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $389.05 / $741.31
| Professional | | $275.42 | $389.05 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $912.01 / $2,570.40
| Facility | | $446.68 | $912.01 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $446.68 / $933.25
| Professional | | $288.40 | $446.68 | $933.25 |
- 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
- $257.04 / $389.05 / $707.95
| Professional | | $257.04 | $389.05 | $707.95 |