- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $3,388.44 / $7,079.46
| Facility | | $489.78 | $3,388.44 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $245.47 / $588.84
| Professional | | $89.13 | $245.47 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,162.28 / $10,471.29
| Facility | | $2,137.96 | $3,162.28 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $177.83 / $331.13
| Professional | | $107.15 | $177.83 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $50.12
| Facility | | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $263.03 / $562.34
| Professional | | $134.90 | $263.03 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.55 / $95.50 / $218.78
| Professional | | $9.55 | $95.50 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $4,570.88 / $9,332.54
| Facility | | $1,905.46 | $4,570.88 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $177.83 / $363.08
| Professional | | $93.33 | $177.83 | $363.08 |