- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $2,818.38 / $8,709.64
| Facility | | $295.12 | $2,818.38 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $234.42 / $457.09
| Professional | | $144.54 | $234.42 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,890.45 / $9,549.93
| Facility | | $1,621.81 | $3,890.45 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $229.09 / $426.58
| Professional | | $144.54 | $229.09 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $295.12 / $1,862.09
| Facility | | $141.25 | $295.12 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $288.40 / $630.96
| Professional | | $169.82 | $288.40 | $630.96 |
- 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
- $144.54 / $234.42 / $446.68
| Professional | | $144.54 | $234.42 | $446.68 |