- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,398.83 / $6,606.93
| Facility | | $501.19 | $2,398.83 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $316.23 / $524.81
| Professional | | $186.21 | $316.23 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $5,370.32 / $7,244.36
| Facility | | $3,981.07 | $5,370.32 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $295.12 / $478.63
| Professional | | $194.98 | $295.12 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $354.81 / $2,290.87
| Facility | | $194.98 | $354.81 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $380.19 / $2,630.27
| Professional | | $275.42 | $380.19 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,995.26 / $3,801.89
| Facility | | $575.44 | $1,995.26 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $269.15 / $416.87
| Professional | | $169.82 | $269.15 | $416.87 |