- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $3,467.37 / $9,549.93
| Facility | | $467.74 | $3,467.37 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $371.54 / $870.96
| Professional | | $245.47 | $371.54 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,570.88 / $11,481.54
| Facility | | $2,041.74 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $501.19 / $912.01
| Professional | | $323.59 | $501.19 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,445.44 / $3,548.13
| Facility | | $489.78 | $1,445.44 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $512.86 / $1,047.13
| Professional | | $309.03 | $512.86 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $2,290.87 / $9,772.37
| Facility | | $660.69 | $2,290.87 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $446.68 / $794.33
| Professional | | $281.84 | $446.68 | $794.33 |