- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $2,884.03 / $8,709.64
| Facility | | $457.09 | $2,884.03 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $380.19 / $794.33
| Professional | | $295.12 | $380.19 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,890.45 / $9,549.93
| Facility | | $1,621.81 | $3,890.45 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $398.11 / $758.58
| Professional | | $269.15 | $398.11 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $870.96 / $2,951.21
| Facility | | $50.12 | $870.96 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $446.68 / $1,023.29
| Professional | | $275.42 | $446.68 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,071.52 / $3,467.37
| Facility | | $229.09 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $354.81 / $660.69
| Professional | | $263.03 | $354.81 | $660.69 |