- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $2,818.38 / $8,709.64
| Facility | | $346.74 | $2,818.38 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $263.03 / $588.84
| Professional | | $199.53 | $263.03 | $588.84 |
- 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
- $190.55 / $275.42 / $524.81
| Professional | | $190.55 | $275.42 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $616.60 / $1,778.28
| Facility | | $123.03 | $616.60 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $323.59 / $707.95
| Professional | | $199.53 | $323.59 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,071.52 / $3,467.37
| Facility | | $229.09 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $257.04 / $478.63
| Professional | | $186.21 | $257.04 | $478.63 |