- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $6,309.57 / $9,549.93
| Facility | | $4,265.80 | $6,309.57 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $61.66 / $363.08
| Professional | | $46.77 | $61.66 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,760.83 / $16,218.10
| Facility | | $2,290.87 | $6,760.83 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $371.54
| Professional | | $50.12 | $50.12 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $524.81 / $776.25
| Professional | | $407.38 | $524.81 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $9,120.11 / $19,498.45
| Facility | | $2,290.87 | $9,120.11 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $81.28 / $870.96
| Professional | | $52.48 | $81.28 | $870.96 |