- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $4,265.80 / $7,079.46
| Facility | | $346.74 | $4,265.80 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $257.04 / $575.44
| Professional | | $104.71 | $257.04 | $575.44 |
- 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
- $123.03 / $223.87 / $398.11
| Professional | | $123.03 | $223.87 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $251.19 / $812.83
| Professional | | $144.54 | $251.19 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $794.33
| Professional | | $398.11 | $398.11 | $794.33 |
- 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
- $109.65 / $275.42 / $741.31
| Professional | | $109.65 | $275.42 | $741.31 |