- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $3,162.28 / $9,332.54
| Facility | | $537.03 | $3,162.28 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $229.09 / $436.52
| Professional | | $190.55 | $229.09 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $3,630.78 / $8,709.64
| Facility | | $1,380.38 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $208.93 / $446.68
| Professional | | $141.25 | $208.93 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $524.81 / $1,318.26
| Facility | | $331.13 | $524.81 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $288.40 / $602.56
| Professional | | $181.97 | $288.40 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $1,819.70 / $4,570.88
| Facility | | $446.68 | $1,819.70 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $234.42 / $436.52
| Professional | | $165.96 | $234.42 | $436.52 |