- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $2,818.38 / $8,912.51
| Facility | | $478.63 | $2,818.38 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $354.81 / $758.58
| Professional | | $263.03 | $354.81 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,495.41 / $12,302.69
| Facility | | $1,995.26 | $5,495.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $426.58 / $794.33
| Professional | | $309.03 | $426.58 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $1,122.02 / $3,311.31
| Facility | | $158.49 | $1,122.02 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $512.86 / $1,047.13
| Professional | | $323.59 | $512.86 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $1,096.48 / $3,467.37
| Facility | | $245.47 | $1,096.48 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $436.52 / $812.83
| Professional | | $295.12 | $436.52 | $812.83 |