- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $1,174.90 / $6,456.54
| Facility | | $275.42 | $1,174.90 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $295.12 / $794.33
| Professional | | $169.82 | $295.12 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,715.35 / $9,549.93
| Facility | | $1,513.56 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $281.84 / $575.44
| Professional | | $181.97 | $281.84 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $501.19 / $2,344.23
| Facility | | $199.53 | $501.19 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $346.74 / $776.25
| Professional | | $208.93 | $346.74 | $776.25 |
- 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 / $281.84 / $524.81
| Professional | | $177.83 | $281.84 | $524.81 |