- 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
- $151.36 / $257.04 / $501.19
| Professional | | $151.36 | $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
- $154.88 / $245.47 / $467.74
| Professional | | $154.88 | $245.47 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $691.83 / $2,187.76
| Facility | | $50.12 | $691.83 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $316.23 / $707.95
| Professional | | $177.83 | $316.23 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $1,071.52 / $3,467.37
| Facility | | $199.53 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $263.03 / $501.19
| Professional | | $151.36 | $263.03 | $501.19 |