- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $5,495.41 / $9,549.93
| Facility | | $616.60 | $5,495.41 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $323.59 / $645.65
| Professional | | $213.80 | $323.59 | $645.65 |
- 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
- $263.03 / $478.63 / $645.65
| Professional | | $263.03 | $478.63 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $446.68 / $831.76
| Professional | | $218.78 | $446.68 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $389.05 / $588.84
| Professional | | $229.09 | $389.05 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,079.46 / $11,220.18
| Facility | | $4,570.88 | $7,079.46 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $323.59 / $630.96
| Professional | | $204.17 | $323.59 | $630.96 |