- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $2,344.23 / $8,317.64
| Facility | | $288.40 | $2,344.23 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $257.04 / $616.60
| Professional | | $162.18 | $257.04 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,630.78 / $8,709.64
| Facility | | $1,479.11 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $275.42 / $549.54
| Professional | | $177.83 | $275.42 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $794.33 / $2,238.72
| Facility | | $288.40 | $794.33 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $331.13 / $724.44
| Professional | | $194.98 | $331.13 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $1,202.26 / $3,548.13
| Facility | | $316.23 | $1,202.26 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $269.15 / $501.19
| Professional | | $165.96 | $269.15 | $501.19 |