- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $2,187.76 / $7,943.28
| Facility | | $102.33 | $2,187.76 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $102.33 / $281.84
| Professional | | $51.29 | $102.33 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,715.35 / $9,549.93
| Facility | | $1,548.82 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $117.49 / $218.78
| Professional | | $63.10 | $117.49 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.26 / $138.04 / $741.31
| Facility | | $60.26 | $138.04 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $134.90 / $275.42
| Professional | | $69.18 | $134.90 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,122.02 / $3,467.37
| Facility | | $295.12 | $1,122.02 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $104.71 / $208.93
| Professional | | $56.23 | $104.71 | $208.93 |