- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $2,818.38 / $8,912.51
| Facility | | $380.19 | $2,818.38 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $288.40 / $549.54
| Professional | | $147.91 | $288.40 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,630.78 / $8,709.64
| Facility | | $1,445.44 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $239.88 / $489.78
| Professional | | $138.04 | $239.88 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $691.83 / $2,454.71
| Facility | | $257.04 | $691.83 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $346.74 / $776.25
| Professional | | $169.82 | $346.74 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,949.84 / $4,677.35
| Facility | | $645.65 | $1,949.84 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $302.00 / $616.60
| Professional | | $151.36 | $302.00 | $616.60 |