- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,388.44 / $9,772.37
| Facility | | $933.25 | $3,388.44 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $91.20 / $371.54
| Professional | | $60.26 | $91.20 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,168.69 / $12,022.64
| Facility | | $2,344.23 | $4,168.69 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $93.33 / $223.87
| Professional | | $47.86 | $93.33 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $309.03 / $851.14
| Facility | | $162.18 | $309.03 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $134.90 / $186.21
| Professional | | $107.15 | $134.90 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $1,174.90 / $3,630.78
| Facility | | $251.19 | $1,174.90 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $107.15 / $194.98
| Professional | | $74.13 | $107.15 | $194.98 |