- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $1,737.80 / $7,079.46
| Facility | | $281.84 | $1,737.80 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $316.23 / $776.25
| Professional | | $177.83 | $316.23 | $776.25 |
- 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
- $181.97 / $295.12 / $602.56
| Professional | | $181.97 | $295.12 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,174.90 / $3,019.95
| Facility | | $346.74 | $1,174.90 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $363.08 / $794.33
| Professional | | $208.93 | $363.08 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,122.02 / $3,467.37
| Facility | | $302.00 | $1,122.02 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $288.40 / $549.54
| Professional | | $177.83 | $288.40 | $549.54 |