- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $3,715.35 / $10,715.19
| Facility | | $257.04 | $3,715.35 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $257.04 / $501.19
| Professional | | $154.88 | $257.04 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,786.30 / $10,471.29
| Facility | | $1,819.70 | $4,786.30 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $245.47 / $457.09
| Professional | | $151.36 | $245.47 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $691.83 / $2,238.72
| Facility | | $50.12 | $691.83 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $309.03 / $724.44
| Professional | | $177.83 | $309.03 | $724.44 |
- 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
- $151.36 / $251.19 / $501.19
| Professional | | $151.36 | $251.19 | $501.19 |