- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $2,884.03 / $8,912.51
| Facility | | $323.59 | $2,884.03 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $251.19 / $478.63
| Professional | | $158.49 | $251.19 | $478.63 |
- 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
- $144.54 / $229.09 / $457.09
| Professional | | $144.54 | $229.09 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $346.74 / $1,949.84
| Facility | | $158.49 | $346.74 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $295.12 / $691.83
| Professional | | $162.18 | $295.12 | $691.83 |
- 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
- $147.91 / $234.42 / $446.68
| Professional | | $147.91 | $234.42 | $446.68 |