- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $2,630.27 / $8,511.38
| Facility | | $338.84 | $2,630.27 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $263.03 / $562.34
| Professional | | $208.93 | $263.03 | $562.34 |
- 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
- $186.21 / $295.12 / $562.34
| Professional | | $186.21 | $295.12 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $616.60 / $1,995.26
| Facility | | $50.12 | $616.60 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $354.81 / $741.31
| Professional | | $234.42 | $354.81 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $1,071.52 / $3,467.37
| Facility | | $204.17 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $288.40 / $537.03
| Professional | | $199.53 | $288.40 | $537.03 |