- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $1,230.27 / $2,041.74
| Facility | | $234.42 | $1,230.27 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $295.12 / $457.09
| Professional | | $169.82 | $295.12 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $6,760.83 / $9,120.11
| Facility | | $6,760.83 | $6,760.83 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $263.03 / $457.09
| Professional | | $199.53 | $263.03 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $2,630.27 / $2,630.27
| Facility | | $2,630.27 | $2,630.27 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $316.23 / $562.34
| Professional | | $199.53 | $316.23 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,137.96 / $9,549.93
| Facility | | $977.24 | $2,137.96 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $323.59 / $562.34
| Professional | | $173.78 | $323.59 | $562.34 |