- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $4,897.79 / $8,511.38
| Facility | | $331.13 | $4,897.79 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $169.82 / $338.84
| Professional | | $128.82 | $169.82 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,365.16 / $10,964.78
| Facility | | $3,715.35 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $257.04 / $309.03
| Professional | | $154.88 | $257.04 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $234.42 / $398.11
| Professional | | $169.82 | $234.42 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $354.81
| Professional | | $245.47 | $245.47 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,079.46 / $11,220.18
| Facility | | $4,570.88 | $7,079.46 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $213.80 / $407.38
| Professional | | $147.91 | $213.80 | $407.38 |