- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $3,388.44 / $9,120.11
| Facility | | $537.03 | $3,388.44 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $407.38 / $851.14
| Professional | | $204.17 | $407.38 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,715.35 / $8,709.64
| Facility | | $1,548.82 | $3,715.35 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $354.81 / $758.58
| Professional | | $208.93 | $354.81 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $851.14 / $3,388.44
| Facility | | $363.08 | $851.14 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $478.63 / $1,096.48
| Professional | | $234.42 | $478.63 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,949.84 / $4,677.35
| Facility | | $645.65 | $1,949.84 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $436.52 / $933.25
| Professional | | $218.78 | $436.52 | $933.25 |