- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $2,754.23 / $8,511.38
| Facility | | $371.54 | $2,754.23 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $295.12 / $602.56
| Professional | | $131.83 | $295.12 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,630.78 / $8,709.64
| Facility | | $1,445.44 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $218.78 / $467.74
| Professional | | $131.83 | $218.78 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $1,230.27 / $3,388.44
| Facility | | $208.93 | $1,230.27 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $346.74 / $891.25
| Professional | | $151.36 | $346.74 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $1,071.52 / $3,467.37
| Facility | | $213.80 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $281.84 / $616.60
| Professional | | $128.82 | $281.84 | $616.60 |