- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $3,630.78 / $7,413.10
| Facility | | $245.47 | $3,630.78 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $190.55 / $416.87
| Professional | | $112.20 | $190.55 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,238.72 / $3,548.13
| Facility | | $794.33 | $2,238.72 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $208.93 / $346.74
| Professional | | $128.82 | $208.93 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $204.17 / $416.87
| Professional | | $117.49 | $204.17 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $263.03 / $933.25
| Professional | | $131.83 | $263.03 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $1,513.56 / $2,511.89
| Facility | | $354.81 | $1,513.56 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $229.09 / $426.58
| Professional | | $138.04 | $229.09 | $426.58 |