- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $2,884.03 / $8,912.51
| Facility | | $478.63 | $2,884.03 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $389.05 / $707.95
| Professional | | $263.03 | $389.05 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $4,466.84 / $10,232.93
| Facility | | $1,949.84 | $4,466.84 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $354.81 / $724.44
| Professional | | $218.78 | $354.81 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $446.68 / $1,548.82
| Facility | | $288.40 | $446.68 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $426.58 / $933.25
| Professional | | $269.15 | $426.58 | $933.25 |
- 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
- $239.88 / $371.54 / $691.83
| Professional | | $239.88 | $371.54 | $691.83 |