- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $2,818.38 / $8,709.64
| Facility | | $281.84 | $2,818.38 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $213.80 / $562.34
| Professional | | $147.91 | $213.80 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $4,570.88 / $10,232.93
| Facility | | $2,187.76 | $4,570.88 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $223.87 / $398.11
| Professional | | $144.54 | $223.87 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $660.69 / $1,949.84
| Facility | | $131.83 | $660.69 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $281.84 / $602.56
| Professional | | $173.78 | $281.84 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,884.03 / $6,309.57
| Facility | | $1,023.29 | $2,884.03 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $223.87 / $426.58
| Professional | | $144.54 | $223.87 | $426.58 |