- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $4,466.84 / $16,218.10
| Facility | | $234.42 | $4,466.84 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $234.42 / $467.74
| Professional | | $190.55 | $234.42 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $8,511.38 / $11,220.18
| Facility | | $3,981.07 | $8,511.38 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $338.84 / $524.81
| Professional | | $208.93 | $338.84 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $213.80 / $245.47
| Facility | | $208.93 | $213.80 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $275.42 / $478.63
| Professional | | $208.93 | $275.42 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,025.60 / $10,715.19
| Facility | | $2,691.53 | $6,025.60 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $245.47 / $371.54
| Professional | | $194.98 | $245.47 | $371.54 |