- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $3,388.44 / $9,120.11
| Facility | | $446.68 | $3,388.44 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $354.81 / $660.69
| Professional | | $158.49 | $354.81 | $660.69 |
- 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
- $177.83 / $363.08 / $870.96
| Professional | | $177.83 | $363.08 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $1,230.27 / $3,388.44
| Facility | | $281.84 | $1,230.27 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $426.58 / $977.24
| Professional | | $186.21 | $426.58 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,949.84 / $4,677.35
| Facility | | $562.34 | $1,949.84 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $354.81 / $741.31
| Professional | | $162.18 | $354.81 | $741.31 |