- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $3,235.94 / $8,912.51
| Facility | | $275.42 | $3,235.94 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $223.87 / $501.19
| Professional | | $144.54 | $223.87 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,715.35 / $8,912.51
| Facility | | $1,548.82 | $3,715.35 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $257.04 / $501.19
| Professional | | $158.49 | $257.04 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $707.95 / $1,949.84
| Facility | | $245.47 | $707.95 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $281.84 / $602.56
| Professional | | $162.18 | $281.84 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,981.07 / $9,549.93
| Facility | | $1,096.48 | $3,981.07 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $234.42 / $436.52
| Professional | | $141.25 | $234.42 | $436.52 |