- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $2,290.87 / $7,943.28
| Facility | | $281.84 | $2,290.87 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $257.04 / $616.60
| Professional | | $144.54 | $257.04 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,365.16 / $9,549.93
| Facility | | $1,621.81 | $4,365.16 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $269.15 / $537.03
| Professional | | $169.82 | $269.15 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $741.31 / $2,089.30
| Facility | | $213.80 | $741.31 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $309.03 / $676.08
| Professional | | $181.97 | $309.03 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,949.84 / $4,677.35
| Facility | | $575.44 | $1,949.84 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $263.03 / $501.19
| Professional | | $162.18 | $263.03 | $501.19 |