- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $3,548.13 / $9,120.11
| Facility | | $870.96 | $3,548.13 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,071.52 / $2,511.89
| Professional | | $758.58 | $1,071.52 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $239.88 / $316.23
| Facility | | $208.93 | $239.88 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $295.12 / $1,548.82
| Professional | | $67.61 | $295.12 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,019.95 / $6,309.57
| Facility | | $1,047.13 | $3,019.95 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,137.96 / $4,677.35
| Professional | | $1,445.44 | $2,137.96 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,621.81 / $4,677.35
| Facility | | $933.25 | $1,621.81 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $1,047.13 / $2,089.30
| Professional | | $102.33 | $1,047.13 | $2,089.30 |