- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $4,466.84 / $11,220.18
| Facility | | $288.40 | $4,466.84 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $199.53 / $467.74
| Professional | | $162.18 | $199.53 | $467.74 |
- 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
- $181.97 / $275.42 / $489.78
| Professional | | $181.97 | $275.42 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $562.34 / $1,621.81
| Facility | | $50.12 | $562.34 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $309.03 / $630.96
| Professional | | $204.17 | $309.03 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $1,096.48 / $3,467.37
| Facility | | $245.47 | $1,096.48 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $257.04 / $457.09
| Professional | | $181.97 | $257.04 | $457.09 |