- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,884.03 / $8,912.51
| Facility | | $398.11 | $2,884.03 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $316.23 / $562.34
| Professional | | $162.18 | $316.23 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,365.16 / $10,232.93
| Facility | | $1,621.81 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $269.15 / $562.34
| Professional | | $162.18 | $269.15 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $912.01 / $3,019.95
| Facility | | $229.09 | $912.01 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $354.81 / $831.76
| Professional | | $169.82 | $354.81 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $2,041.74 / $5,011.87
| Facility | | $602.56 | $2,041.74 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $288.40 / $562.34
| Professional | | $154.88 | $288.40 | $562.34 |