- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $2,630.27 / $7,762.47
| Facility | | $389.05 | $2,630.27 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $457.09 / $912.01
| Professional | | $223.87 | $457.09 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,981.07 / $9,549.93
| Facility | | $1,513.56 | $3,981.07 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $426.58 / $741.31
| Professional | | $251.19 | $426.58 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $912.01 / $2,570.40
| Facility | | $380.19 | $912.01 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $489.78 / $1,047.13
| Professional | | $257.04 | $489.78 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,511.89 / $6,025.60
| Facility | | $645.65 | $2,511.89 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $426.58 / $812.83
| Professional | | $218.78 | $426.58 | $812.83 |