- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $4,466.84 / $10,964.78
| Facility | | $346.74 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $245.47 / $676.08
| Professional | | $186.21 | $245.47 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,890.45 / $9,549.93
| Facility | | $1,698.24 | $3,890.45 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $316.23 / $562.34
| Professional | | $204.17 | $316.23 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $645.65 / $1,905.46
| Facility | | $162.18 | $645.65 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $354.81 / $741.31
| Professional | | $229.09 | $354.81 | $741.31 |
- 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
- $208.93 / $295.12 / $524.81
| Professional | | $208.93 | $295.12 | $524.81 |