- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $3,715.35 / $10,715.19
| Facility | | $295.12 | $3,715.35 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $309.03 / $630.96
| Professional | | $177.83 | $309.03 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,897.79 / $10,471.29
| Facility | | $1,819.70 | $4,897.79 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $281.84 / $524.81
| Professional | | $158.49 | $281.84 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $776.25 / $2,691.53
| Facility | | $134.90 | $776.25 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $363.08 / $851.14
| Professional | | $194.98 | $363.08 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $1,071.52 / $3,467.37
| Facility | | $223.87 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $288.40 / $588.84
| Professional | | $169.82 | $288.40 | $588.84 |