- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $5,128.61 / $8,709.64
| Facility | | $338.84 | $5,128.61 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $295.12 / $630.96
| Professional | | $204.17 | $295.12 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $6,456.54 / $10,964.78
| Facility | | $3,467.37 | $6,456.54 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $331.13 / $489.78
| Professional | | $239.88 | $331.13 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $346.74 / $489.78
| Professional | | $245.47 | $346.74 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $380.19 / $1,023.29
| Professional | | $263.03 | $380.19 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $257.04 / $269.15
| Professional | | $186.21 | $257.04 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $5,754.40 / $12,302.69
| Facility | | $2,630.27 | $5,754.40 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $354.81 / $575.44
| Professional | | $245.47 | $354.81 | $575.44 |