- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $3,162.28 / $9,332.54
| Facility | | $537.03 | $3,162.28 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $223.87 / $478.63
| Professional | | $177.83 | $223.87 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $1,548.82 / $10,471.29
| Facility | | $199.53 | $1,548.82 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $251.19 / $467.74
| Professional | | $165.96 | $251.19 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $707.95 / $1,949.84
| Facility | | $323.59 | $707.95 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $281.84 / $645.65
| Professional | | $169.82 | $281.84 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,495.41 / $12,589.25
| Facility | | $1,819.70 | $5,495.41 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $218.78 / $407.38
| Professional | | $158.49 | $218.78 | $407.38 |