- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $2,818.38 / $8,912.51
| Facility | | $363.08 | $2,818.38 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $288.40 / $524.81
| Professional | | $181.97 | $288.40 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,365.16 / $10,232.93
| Facility | | $1,548.82 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $257.04 / $524.81
| Professional | | $138.04 | $257.04 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $380.19 / $1,412.54
| Facility | | $245.47 | $380.19 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $309.03 / $691.83
| Professional | | $177.83 | $309.03 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,570.40 / $6,165.95
| Facility | | $645.65 | $2,570.40 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $257.04 / $501.19
| Professional | | $158.49 | $257.04 | $501.19 |