- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $4,466.84 / $10,964.78
| Facility | | $588.84 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $416.87 / $776.25
| Professional | | $346.74 | $416.87 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,128.61 / $13,803.84
| Facility | | $2,570.40 | $5,128.61 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $467.74 / $831.76
| Professional | | $346.74 | $467.74 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $645.65 / $2,089.30
| Facility | | $380.19 | $645.65 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $537.03 / $1,096.48
| Professional | | $371.54 | $537.03 | $1,096.48 |
- 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
- $323.59 / $446.68 / $794.33
| Professional | | $323.59 | $446.68 | $794.33 |