- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $4,570.88 / $11,220.18
| Facility | | $323.59 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $234.42 / $436.52
| Professional | | $194.98 | $234.42 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,495.41 / $11,220.18
| Facility | | $2,290.87 | $5,495.41 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $257.04 / $467.74
| Professional | | $190.55 | $257.04 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $537.03 / $1,513.56
| Facility | | $323.59 | $537.03 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $309.03 / $616.60
| Professional | | $208.93 | $309.03 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $2,818.38 / $9,772.37
| Facility | | $524.81 | $2,818.38 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $245.47 / $446.68
| Professional | | $177.83 | $245.47 | $446.68 |