- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $5,011.87 / $10,232.93
| Facility | | $512.86 | $5,011.87 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $263.03 / $616.60
| Professional | | $151.36 | $263.03 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $11,748.98 / $13,803.84
| Facility | | $6,309.57 | $11,748.98 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $245.47 / $380.19
| Professional | | $177.83 | $245.47 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $371.54 / $660.69
| Professional | | $223.87 | $371.54 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $309.03 / $309.03
| Professional | | $295.12 | $309.03 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,079.46 / $11,220.18
| Facility | | $4,570.88 | $7,079.46 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $251.19 / $446.68
| Professional | | $169.82 | $251.19 | $446.68 |