- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $3,715.35 / $9,549.93
| Facility | | $724.44 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $309.03 / $602.56
| Professional | | $263.03 | $309.03 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $5,888.44 / $13,489.63
| Facility | | $2,238.72 | $5,888.44 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $363.08 / $660.69
| Professional | | $269.15 | $363.08 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $794.33 / $4,570.88
| Facility | | $457.09 | $794.33 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $416.87 / $794.33
| Professional | | $275.42 | $416.87 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,248.07 / $13,182.57
| Facility | | $1,348.96 | $5,248.07 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $346.74 / $616.60
| Professional | | $239.88 | $346.74 | $616.60 |