- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $7,079.46 / $14,125.38
| Facility | | $512.86 | $7,079.46 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $208.93 / $812.83
| Professional | | $158.49 | $208.93 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $660.69
| Professional | | $562.34 | $562.34 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $263.03 / $1,148.15
| Facility | | $190.55 | $263.03 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $660.69 / $1,513.56
| Professional | | $371.54 | $660.69 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $933.25 / $1,096.48
| Professional | | $707.95 | $933.25 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $812.83 / $1,479.11
| Facility | | $245.47 | $812.83 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $177.83 / $660.69
| Professional | | $60.26 | $177.83 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $537.03 / $1,122.02
| Professional | | $416.87 | $537.03 | $1,122.02 |