- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $2,691.53 / $10,232.93
| Facility | | $309.03 | $2,691.53 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $162.18 / $562.34
| Professional | | $114.82 | $162.18 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $213.80 / $446.68
| Professional | | $147.91 | $213.80 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $223.87 / $309.03
| Professional | | $177.83 | $223.87 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,818.38 / $4,466.84
| Facility | | $1,819.70 | $2,818.38 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $177.83 / $354.81
| Professional | | $109.65 | $177.83 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,715.35 / $7,762.47
| Facility | | $1,862.09 | $3,715.35 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $154.88 / $281.84
| Professional | | $109.65 | $154.88 | $281.84 |