- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $3,715.35 / $9,549.93
| Facility | | $831.76 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $467.74 / $1,148.15
| Professional | | $371.54 | $467.74 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $6,760.83 / $13,803.84
| Facility | | $2,754.23 | $6,760.83 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $588.84 / $1,071.52
| Professional | | $426.58 | $588.84 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,348.96 / $3,890.45
| Facility | | $323.59 | $1,348.96 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $676.08 / $1,445.44
| Professional | | $436.52 | $676.08 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $549.54 / $1,023.29
| Professional | | $398.11 | $549.54 | $1,023.29 |