- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $3,162.28 / $8,912.51
| Facility | | $316.23 | $3,162.28 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $269.15 / $524.81
| Professional | | $154.88 | $269.15 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $5,011.87 / $10,964.78
| Facility | | $1,698.24 | $5,011.87 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $239.88 / $501.19
| Professional | | $147.91 | $239.88 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $1,122.02 / $2,570.40
| Facility | | $275.42 | $1,122.02 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $295.12 / $660.69
| Professional | | $165.96 | $295.12 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,691.53 / $6,606.93
| Facility | | $645.65 | $2,691.53 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $245.47 / $467.74
| Professional | | $144.54 | $245.47 | $467.74 |