- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $4,570.88 / $8,511.38
| Facility | | $245.47 | $4,570.88 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $114.82 / $199.53
| Professional | | $47.86 | $114.82 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $5,888.44 / $8,128.31
| Facility | | $5,370.32 | $5,888.44 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $134.90 / $346.74
| Professional | | $79.43 | $134.90 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $128.82 / $346.74
| Professional | | $56.23 | $128.82 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $218.78 / $724.44
| Professional | | $186.21 | $218.78 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,890.45 / $6,760.83
| Facility | | $1,288.25 | $3,890.45 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $114.82 / $302.00
| Professional | | $50.12 | $114.82 | $302.00 |