- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,412.54 / $2,041.74
| Facility | | $229.09 | $1,412.54 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $204.17 / $331.13
| Professional | | $173.78 | $204.17 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $3,981.07
| Facility | | $2,884.03 | $2,884.03 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $208.93 / $275.42
| Professional | | $208.93 | $208.93 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $562.34 / $2,511.89
| Facility | | $512.86 | $562.34 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $251.19 / $338.84
| Professional | | $181.97 | $251.19 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,819.70 / $7,079.46
| Facility | | $812.83 | $1,819.70 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $223.87 / $346.74
| Professional | | $165.96 | $223.87 | $346.74 |