- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $2,691.53 / $8,511.38
| Facility | | $275.42 | $2,691.53 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $223.87 / $478.63
| Professional | | $138.04 | $223.87 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,365.16 / $9,549.93
| Facility | | $1,584.89 | $4,365.16 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $245.47 / $478.63
| Professional | | $154.88 | $245.47 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $676.08 / $1,905.46
| Facility | | $190.55 | $676.08 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $281.84 / $616.60
| Professional | | $162.18 | $281.84 | $616.60 |
- 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
- $147.91 / $234.42 / $446.68
| Professional | | $147.91 | $234.42 | $446.68 |