- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $2,818.38 / $8,912.51
| Facility | | $338.84 | $2,818.38 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $263.03 / $467.74
| Professional | | $104.71 | $263.03 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,630.78 / $9,120.11
| Facility | | $1,513.56 | $3,630.78 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $251.19 / $562.34
| Professional | | $112.20 | $251.19 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $676.08 / $2,137.96
| Facility | | $173.78 | $676.08 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $288.40 / $707.95
| Professional | | $120.23 | $288.40 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,096.48 / $3,467.37
| Facility | | $295.12 | $1,096.48 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $245.47 / $537.03
| Professional | | $104.71 | $245.47 | $537.03 |