- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $2,754.23 / $8,912.51
| Facility | | $281.84 | $2,754.23 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $234.42 / $489.78
| Professional | | $162.18 | $234.42 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,365.16 / $10,232.93
| Facility | | $1,621.81 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $229.09 / $436.52
| Professional | | $147.91 | $229.09 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $281.84 / $1,023.29
| Facility | | $151.36 | $281.84 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $275.42 / $562.34
| Professional | | $169.82 | $275.42 | $562.34 |
- 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
- $147.91 / $229.09 / $416.87
| Professional | | $147.91 | $229.09 | $416.87 |