- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $3,162.28 / $9,120.11
| Facility | | $467.74 | $3,162.28 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $181.97 / $524.81
| Professional | | $144.54 | $181.97 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,890.45 / $9,549.93
| Facility | | $1,621.81 | $3,890.45 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $239.88 / $426.58
| Professional | | $158.49 | $239.88 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $501.19 / $3,801.89
| Facility | | $269.15 | $501.19 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $275.42 / $562.34
| Professional | | $177.83 | $275.42 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $1,071.52 / $3,467.37
| Facility | | $245.47 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $223.87 / $398.11
| Professional | | $158.49 | $223.87 | $398.11 |