- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $4,365.16 / $7,079.46
| Facility | | $338.84 | $4,365.16 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $186.21 / $478.63
| Professional | | $117.49 | $186.21 | $478.63 |
- 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
- $151.36 / $275.42 / $426.58
| Professional | | $151.36 | $275.42 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $263.03 / $398.11
| Professional | | $154.88 | $263.03 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $295.12 / $346.74
| Professional | | $295.12 | $295.12 | $346.74 |
- 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
- $125.89 / $208.93 / $407.38
| Professional | | $125.89 | $208.93 | $407.38 |