- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $2,818.38 / $8,709.64
| Facility | | $380.19 | $2,818.38 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $323.59 / $602.56
| Professional | | $147.91 | $323.59 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,495.41 / $13,489.63
| Facility | | $2,570.40 | $5,495.41 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $263.03 / $512.86
| Professional | | $147.91 | $263.03 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $912.01 / $2,570.40
| Facility | | $34.67 | $912.01 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $354.81 / $776.25
| Professional | | $181.97 | $354.81 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,148.15 / $3,630.78
| Facility | | $295.12 | $1,148.15 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $331.13 / $645.65
| Professional | | $165.96 | $331.13 | $645.65 |