- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,884.03 / $8,912.51
| Facility | | $537.03 | $2,884.03 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $436.52 / $851.14
| Professional | | $316.23 | $436.52 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,570.88 / $10,232.93
| Facility | | $2,238.72 | $4,570.88 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $407.38 / $812.83
| Professional | | $281.84 | $407.38 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $602.56 / $3,311.31
| Facility | | $275.42 | $602.56 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $512.86 / $1,230.27
| Professional | | $316.23 | $512.86 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $4,168.69 / $9,549.93
| Facility | | $1,445.44 | $4,168.69 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $407.38 / $776.25
| Professional | | $288.40 | $407.38 | $776.25 |