- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,890.45 / $7,762.47
| Facility | | $1,288.25 | $3,890.45 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $186.21 / $275.42
| Professional | | $147.91 | $186.21 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $257.04 / $309.03
| Professional | | $173.78 | $257.04 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $5,248.07 / $14,454.40
| Facility | | $218.78 | $5,248.07 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $208.93 / $3,311.31
| Professional | | $147.91 | $208.93 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $7,762.47 / $14,454.40
| Facility | | $1,949.84 | $7,762.47 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $194.98 / $281.84
| Professional | | $144.54 | $194.98 | $281.84 |