- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $3,311.31 / $9,549.93
| Facility | | $758.58 | $3,311.31 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $93.33 / $398.11
| Professional | | $57.54 | $93.33 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,715.35 / $9,549.93
| Facility | | $1,621.81 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $125.89 / $234.42
| Professional | | $67.61 | $125.89 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $354.81 / $1,122.02
| Facility | | $112.20 | $354.81 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $109.65 / $158.49
| Professional | | $72.44 | $109.65 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $1,071.52 / $3,467.37
| Facility | | $213.80 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $102.33 / $186.21
| Professional | | $61.66 | $102.33 | $186.21 |