- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $2,884.03 / $9,332.54
| Facility | | $478.63 | $2,884.03 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $363.08 / $707.95
| Professional | | $251.19 | $363.08 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,677.35 / $13,489.63
| Facility | | $1,548.82 | $4,677.35 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $501.19 / $1,047.13
| Professional | | $257.04 | $501.19 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $851.14 / $7,413.10
| Facility | | $263.03 | $851.14 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $512.86 / $977.24
| Professional | | $257.04 | $512.86 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,495.41 / $12,589.25
| Facility | | $1,819.70 | $5,495.41 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $426.58 / $758.58
| Professional | | $239.88 | $426.58 | $758.58 |