- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $521.02 / $3,316.32 / $9,784.45
| Facility | | $521.02 | $3,316.32 | $9,784.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.59 / $214.43 / $418.38
| Professional | | $104.59 | $214.43 | $418.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.05 / $206.50 / $245.85
| Facility | | $188.05 | $206.50 | $245.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.53 / $218.53 / $218.53
| Professional | | $218.53 | $218.53 | $218.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $331.13
| Facility | | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.07 / $331.07 / $941.68
| Professional | | $209.07 | $331.07 | $941.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,844.32 / $3,512.82 / $9,085.87
| Facility | | $1,844.32 | $3,512.82 | $9,085.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.22 / $283.56 / $535.88
| Professional | | $206.22 | $283.56 | $535.88 |