- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $4,897.79 / $10,471.29
| Facility | | $371.54 | $4,897.79 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $223.87 / $575.44
| Professional | | $158.49 | $223.87 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,162.28 / $10,471.29
| Facility | | $2,137.96 | $3,162.28 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $380.19 / $501.19
| Professional | | $190.55 | $380.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $3,388.44 / $4,466.84
| Facility | | $50.12 | $3,388.44 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $331.13 / $446.68
| Professional | | $245.47 | $331.13 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $371.54
| Professional | | $363.08 | $363.08 | $371.54 |
- 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
- $199.53 / $275.42 / $467.74
| Professional | | $199.53 | $275.42 | $467.74 |