- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $4,897.79 / $11,481.54
| Facility | | $645.65 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $204.17 / $436.52
| Professional | | $169.82 | $204.17 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $4,365.16 / $9,120.11
| Facility | | $2,089.30 | $4,365.16 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $275.42 / $457.09
| Professional | | $190.55 | $275.42 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50,118.72 / $50,118.72 / $53,703.18
| Facility | | $50,118.72 | $50,118.72 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $169.82 / $181.97
| Professional | | $134.90 | $169.82 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $125.89 / $323.59
| Professional | | $75.86 | $125.89 | $323.59 |