- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $2,570.40 / $8,511.38
| Facility | | $234.42 | $2,570.40 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $251.19 / $602.56
| Professional | | $125.89 | $251.19 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,715.35 / $8,709.64
| Facility | | $1,513.56 | $3,715.35 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $199.53 / $380.19
| Professional | | $104.71 | $199.53 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $371.54 / $1,819.70
| Facility | | $154.88 | $371.54 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $275.42 / $588.84
| Professional | | $147.91 | $275.42 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,949.84 / $4,677.35
| Facility | | $562.34 | $1,949.84 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $229.09 / $446.68
| Professional | | $123.03 | $229.09 | $446.68 |