- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $4,570.88 / $8,511.38
| Facility | | $389.05 | $4,570.88 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $199.53 / $371.54
| Professional | | $131.83 | $199.53 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,365.16 / $10,964.78
| Facility | | $3,715.35 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $245.47 / $407.38
| Professional | | $173.78 | $245.47 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $257.04 / $537.03
| Professional | | $120.23 | $257.04 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $245.47 / $309.03
| Professional | | $147.91 | $245.47 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $6,025.60 / $9,332.54
| Facility | | $3,388.44 | $6,025.60 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $194.98 / $407.38
| Professional | | $128.82 | $194.98 | $407.38 |