- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,090.30 / $6,309.57
| Facility | | $1,445.44 | $3,090.30 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $512.86 / $794.33
| Professional | | $154.88 | $512.86 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.15 / $120.23 / $177.83
| Facility | | $37.15 | $120.23 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $128.82 / $309.03
| Professional | | $64.57 | $128.82 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $1,202.26 / $2,041.74
| Facility | | $316.23 | $1,202.26 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $50.12 / $169.82
| Professional | | $41.69 | $50.12 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $1,122.02 / $2,187.76
| Facility | | $338.84 | $1,122.02 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $47.86 / $190.55
| Professional | | $40.74 | $47.86 | $190.55 |