- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $2,570.40 / $8,511.38
| Facility | | $162.18 | $2,570.40 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $151.36 / $338.84
| Professional | | $67.61 | $151.36 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,466.84 / $10,471.29
| Facility | | $1,621.81 | $4,466.84 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $169.82 / $363.08
| Professional | | $81.28 | $169.82 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $501.19 / $1,479.11
| Facility | | $109.65 | $501.19 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $190.55 / $426.58
| Professional | | $83.18 | $190.55 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $2,041.74 / $5,011.87
| Facility | | $691.83 | $2,041.74 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $147.91 / $309.03
| Professional | | $69.18 | $147.91 | $309.03 |