- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $4,365.16 / $10,964.78
| Facility | | $676.08 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $177.83 / $426.58
| Professional | | $147.91 | $177.83 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $7,079.46 / $13,803.84
| Facility | | $2,754.23 | $7,079.46 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $239.88 / $446.68
| Professional | | $147.91 | $239.88 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $562.34 / $2,290.87
| Facility | | $295.12 | $562.34 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $263.03 / $549.54
| Professional | | $169.82 | $263.03 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,174.90 / $3,630.78
| Facility | | $269.15 | $1,174.90 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $208.93 / $380.19
| Professional | | $144.54 | $208.93 | $380.19 |