- 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
- $19.95 / $154.88 / $288.40
| Professional | | $19.95 | $154.88 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,623.41 / $12,302.69
| Facility | | $2,089.30 | $5,623.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $151.36 / $281.84
| Professional | | $104.71 | $151.36 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $549.54 / $1,380.38
| Facility | | $363.08 | $549.54 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $218.78 / $616.60
| Professional | | $173.78 | $218.78 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,202.26 / $3,548.13
| Facility | | $309.03 | $1,202.26 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $213.80 / $416.87
| Professional | | $147.91 | $213.80 | $416.87 |