- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $2,818.38 / $8,709.64
| Facility | | $467.74 | $2,818.38 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $346.74 / $741.31
| Professional | | $263.03 | $346.74 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,677.35 / $10,471.29
| Facility | | $1,819.70 | $4,677.35 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $416.87 / $776.25
| Professional | | $302.00 | $416.87 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $1,071.52 / $3,162.28
| Facility | | $162.18 | $1,071.52 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $512.86 / $1,023.29
| Professional | | $323.59 | $512.86 | $1,023.29 |
- 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 / $426.58 / $776.25
| Professional | | $295.12 | $426.58 | $776.25 |