- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $4,677.35 / $8,511.38
| Facility | | $524.81 | $4,677.35 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $275.42 / $691.83
| Professional | | $144.54 | $275.42 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,162.28 / $10,471.29
| Facility | | $2,137.96 | $3,162.28 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $269.15 / $398.11
| Professional | | $190.55 | $269.15 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $338.84 / $575.44
| Professional | | $213.80 | $338.84 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $229.09 / $346.74
| Professional | | $120.23 | $229.09 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $4,570.88 / $9,332.54
| Facility | | $1,905.46 | $4,570.88 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $269.15 / $467.74
| Professional | | $173.78 | $269.15 | $467.74 |