- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $2,884.03 / $8,912.51
| Facility | | $512.86 | $2,884.03 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $446.68 / $851.14
| Professional | | $138.04 | $446.68 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,981.07 / $11,220.18
| Facility | | $1,621.81 | $3,981.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $524.81 / $1,202.26
| Professional | | $162.18 | $524.81 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $1,258.93 / $3,548.13
| Facility | | $151.36 | $1,258.93 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $467.74 / $1,318.26
| Professional | | $173.78 | $467.74 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,202.26 / $3,630.78
| Facility | | $295.12 | $1,202.26 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $457.09 / $1,071.52
| Professional | | $151.36 | $457.09 | $1,071.52 |