- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $4,897.79 / $20,417.38
| Facility | | $204.17 | $4,897.79 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $446.68 / $724.44
| Professional | | $154.88 | $446.68 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $275.42 / $50,118.72
| Facility | | $144.54 | $275.42 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $338.84 / $851.14
| Professional | | $144.54 | $338.84 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $147.91 / $158.49
| Facility | | $134.90 | $147.91 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $467.74 / $933.25
| Professional | | $154.88 | $467.74 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,290.87 / $7,413.10
| Facility | | $933.25 | $2,290.87 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $446.68 / $977.24
| Professional | | $144.54 | $446.68 | $977.24 |