- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $2,818.38 / $8,709.64
| Facility | | $288.40 | $2,818.38 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $218.78 / $446.68
| Professional | | $169.82 | $218.78 | $446.68 |
- 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
- $134.90 / $223.87 / $436.52
| Professional | | $134.90 | $223.87 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $323.59 / $1,445.44
| Facility | | $128.82 | $323.59 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $288.40 / $616.60
| Professional | | $190.55 | $288.40 | $616.60 |
- 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
- $162.18 / $229.09 / $426.58
| Professional | | $162.18 | $229.09 | $426.58 |