- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $4,466.84 / $10,964.78
| Facility | | $263.03 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $181.97 / $346.74
| Professional | | $151.36 | $181.97 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,265.80 / $10,964.78
| Facility | | $2,238.72 | $4,265.80 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $199.53 / $398.11
| Professional | | $147.91 | $199.53 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $407.38 / $1,122.02
| Facility | | $34.67 | $407.38 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $239.88 / $478.63
| Professional | | $162.18 | $239.88 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $1,047.13 / $3,467.37
| Facility | | $158.49 | $1,047.13 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $199.53 / $346.74
| Professional | | $141.25 | $199.53 | $346.74 |