- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $4,570.88 / $11,220.18
| Facility | | $660.69 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $489.78 / $891.25
| Professional | | $416.87 | $489.78 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,128.61 / $13,489.63
| Facility | | $2,570.40 | $5,128.61 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $524.81 / $977.24
| Professional | | $389.05 | $524.81 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $776.25 / $3,311.31
| Facility | | $398.11 | $776.25 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $602.56 / $1,258.93
| Professional | | $407.38 | $602.56 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $2,818.38 / $9,772.37
| Facility | | $524.81 | $2,818.38 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $524.81 / $933.25
| Professional | | $371.54 | $524.81 | $933.25 |