- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $3,162.28 / $9,332.54
| Facility | | $758.58 | $3,162.28 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $489.78 / $1,071.52
| Professional | | $389.05 | $489.78 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,365.16 / $10,232.93
| Facility | | $1,621.81 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $549.54 / $1,047.13
| Professional | | $371.54 | $549.54 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,288.25 / $3,630.78
| Facility | | $660.69 | $1,288.25 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $645.65 / $1,412.54
| Professional | | $416.87 | $645.65 | $1,412.54 |
- 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
- $363.08 / $524.81 / $977.24
| Professional | | $363.08 | $524.81 | $977.24 |