- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $4,570.88 / $8,511.38
| Facility | | $275.42 | $4,570.88 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $144.54 / $234.42
| Professional | | $85.11 | $144.54 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $10,232.93 / $10,232.93
| Facility | | $10,232.93 | $10,232.93 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $204.17 / $323.59
| Professional | | $134.90 | $204.17 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $186.21 / $338.84
| Professional | | $112.20 | $186.21 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $223.87 / $281.84
| Professional | | $223.87 | $223.87 | $281.84 |
- 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
- $102.33 / $190.55 / $389.05
| Professional | | $102.33 | $190.55 | $389.05 |