- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $3,630.78 / $8,709.64
| Facility | | $407.38 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $457.09 / $1,318.26
| Professional | | $234.42 | $457.09 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,128.61 / $10,964.78
| Facility | | $1,819.70 | $5,128.61 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $426.58 / $851.14
| Professional | | $239.88 | $426.58 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $1,202.26 / $3,019.95
| Facility | | $389.05 | $1,202.26 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $467.74 / $977.24
| Professional | | $251.19 | $467.74 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,265.80 / $9,549.93
| Facility | | $1,513.56 | $4,265.80 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $389.05 / $758.58
| Professional | | $218.78 | $389.05 | $758.58 |