- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $3,630.78 / $8,317.64
| Facility | | $407.38 | $3,630.78 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $218.78 / $489.78
| Professional | | $177.83 | $218.78 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $5,248.07 / $5,495.41
| Facility | | $398.11 | $5,248.07 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $309.03 / $309.03
| Professional | | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $257.04 / $407.38
| Professional | | $190.55 | $257.04 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $1,348.96 / $12,022.64
| Facility | | $223.87 | $1,348.96 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $239.88 / $3,311.31
| Professional | | $194.98 | $239.88 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,754.23 / $4,677.35
| Facility | | $1,548.82 | $2,754.23 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $234.42 / $316.23
| Professional | | $194.98 | $234.42 | $316.23 |