- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $3,715.35 / $10,715.19
| Facility | | $281.84 | $3,715.35 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $275.42 / $537.03
| Professional | | $169.82 | $275.42 | $537.03 |
- 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
- $173.78 / $275.42 / $512.86
| Professional | | $173.78 | $275.42 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $338.84 / $2,398.83
| Facility | | $141.25 | $338.84 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $338.84 / $776.25
| Professional | | $194.98 | $338.84 | $776.25 |
- 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
- $165.96 / $281.84 / $549.54
| Professional | | $165.96 | $281.84 | $549.54 |