- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $2,818.38 / $8,912.51
| Facility | | $323.59 | $2,818.38 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $229.09 / $457.09
| Professional | | $147.91 | $229.09 | $457.09 |
- 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 / $208.93 / $446.68
| Professional | | $138.04 | $208.93 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $776.25 / $1,778.28
| Facility | | $263.03 | $776.25 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $295.12 / $616.60
| Professional | | $165.96 | $295.12 | $616.60 |
- 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
- $141.25 / $245.47 / $467.74
| Professional | | $141.25 | $245.47 | $467.74 |