- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $5,495.41 / $9,549.93
| Facility | | $363.08 | $5,495.41 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $186.21 / $478.63
| Professional | | $120.23 | $186.21 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $5,888.44 / $8,128.31
| Facility | | $3,801.89 | $5,888.44 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $323.59 / $446.68
| Professional | | $158.49 | $323.59 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $275.42 / $478.63
| Professional | | $165.96 | $275.42 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $239.88 / $239.88
| Professional | | $229.09 | $239.88 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,890.45 / $6,760.83
| Facility | | $1,288.25 | $3,890.45 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $194.98 / $338.84
| Professional | | $131.83 | $194.98 | $338.84 |