- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $3,162.28 / $9,332.54
| Facility | | $512.86 | $3,162.28 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $194.98 / $346.74
| Professional | | $125.89 | $194.98 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,801.89 / $9,549.93
| Facility | | $1,621.81 | $3,801.89 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $177.83 / $331.13
| Professional | | $123.03 | $177.83 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $316.23 / $1,230.27
| Facility | | $223.87 | $316.23 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $208.93 / $489.78
| Professional | | $125.89 | $208.93 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $1,096.48 / $3,388.44
| Facility | | $245.47 | $1,096.48 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $177.83 / $338.84
| Professional | | $114.82 | $177.83 | $338.84 |