- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $5,370.32 / $9,549.93
| Facility | | $234.42 | $5,370.32 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $154.88 / $346.74
| Professional | | $125.89 | $154.88 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,677.35 / $9,772.37
| Facility | | $1,995.26 | $4,677.35 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $263.03 / $467.74
| Professional | | $165.96 | $263.03 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $275.42 / $562.34
| Professional | | $165.96 | $275.42 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $162.18 / $1,778.28
| Professional | | $141.25 | $162.18 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,235.94 / $8,128.31
| Facility | | $1,047.13 | $3,235.94 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $218.78 / $426.58
| Professional | | $138.04 | $218.78 | $426.58 |