- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $3,162.28 / $9,332.54
| Facility | | $575.44 | $3,162.28 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $288.40 / $537.03
| Professional | | $223.87 | $288.40 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $4,570.88 / $10,232.93
| Facility | | $2,137.96 | $4,570.88 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $269.15 / $549.54
| Professional | | $194.98 | $269.15 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $812.83 / $2,344.23
| Facility | | $457.09 | $812.83 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $346.74 / $758.58
| Professional | | $223.87 | $346.74 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $2,630.27 / $6,606.93
| Facility | | $660.69 | $2,630.27 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $281.84 / $537.03
| Professional | | $199.53 | $281.84 | $537.03 |