- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,570.40 / $6,606.93
| Facility | | $794.33 | $2,570.40 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $323.59 / $512.86
| Professional | | $158.49 | $323.59 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,495.41 / $8,709.64
| Facility | | $3,467.37 | $5,495.41 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $295.12 / $501.19
| Professional | | $154.88 | $295.12 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $354.81 / $575.44
| Professional | | $181.97 | $354.81 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $501.19 / $2,818.38
| Facility | | $181.97 | $501.19 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $537.03 / $3,388.44
| Professional | | $331.13 | $537.03 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,348.96 / $2,754.23
| Facility | | $371.54 | $1,348.96 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $288.40 / $588.84
| Professional | | $151.36 | $288.40 | $588.84 |