- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $2,818.38 / $8,709.64
| Facility | | $354.81 | $2,818.38 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $281.84 / $562.34
| Professional | | $131.83 | $281.84 | $562.34 |
- 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
- $125.89 / $213.80 / $478.63
| Professional | | $125.89 | $213.80 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $645.65 / $2,344.23
| Facility | | $234.42 | $645.65 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $331.13 / $741.31
| Professional | | $151.36 | $331.13 | $741.31 |
- 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
- $128.82 / $269.15 / $562.34
| Professional | | $128.82 | $269.15 | $562.34 |