- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $3,162.28 / $9,332.54
| Facility | | $724.44 | $3,162.28 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $512.86 / $954.99
| Professional | | $346.74 | $512.86 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $6,456.54 / $12,589.25
| Facility | | $2,041.74 | $6,456.54 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $524.81 / $1,047.13
| Professional | | $338.84 | $524.81 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $1,258.93 / $3,548.13
| Facility | | $354.81 | $1,258.93 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $630.96 / $1,513.56
| Professional | | $371.54 | $630.96 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,288.25 / $4,168.69
| Facility | | $269.15 | $1,288.25 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $467.74 / $891.25
| Professional | | $338.84 | $467.74 | $891.25 |