- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $4,677.35 / $12,022.64
| Facility | | $524.81 | $4,677.35 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $457.09 / $870.96
| Professional | | $275.42 | $457.09 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $6,456.54 / $14,791.08
| Facility | | $2,089.30 | $6,456.54 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $537.03 / $1,148.15
| Professional | | $269.15 | $537.03 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $933.25 / $11,748.98
| Facility | | $295.12 | $933.25 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $575.44 / $1,071.52
| Professional | | $275.42 | $575.44 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,862.09 / $4,677.35
| Facility | | $467.74 | $1,862.09 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $478.63 / $870.96
| Professional | | $251.19 | $478.63 | $870.96 |