- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $4,570.88 / $11,481.54
| Facility | | $954.99 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $812.83 / $1,778.28
| Professional | | $660.69 | $812.83 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $8,709.64 / $16,595.87
| Facility | | $3,388.44 | $8,709.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $933.25 / $1,737.80
| Professional | | $645.65 | $933.25 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,819.70 / $5,128.61
| Facility | | $398.11 | $1,819.70 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,096.48 / $2,398.83
| Professional | | $691.83 | $1,096.48 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,981.07 / $9,549.93
| Facility | | $1,548.82 | $3,981.07 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $891.25 / $1,659.59
| Professional | | $630.96 | $891.25 | $1,659.59 |