- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $3,890.45 / $10,471.29
| Facility | | $467.74 | $3,890.45 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $346.74 / $660.69
| Professional | | $138.04 | $346.74 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,248.07 / $11,220.18
| Facility | | $2,290.87 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $295.12 / $741.31
| Professional | | $181.97 | $295.12 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $870.96 / $2,187.76
| Facility | | $239.88 | $870.96 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $446.68 / $831.76
| Professional | | $186.21 | $446.68 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $4,073.80 / $9,549.93
| Facility | | $1,318.26 | $4,073.80 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $446.68 / $794.33
| Professional | | $269.15 | $446.68 | $794.33 |