- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $2,691.53 / $8,709.64
| Facility | | $208.93 | $2,691.53 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $173.78 / $380.19
| Professional | | $104.71 | $173.78 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,365.16 / $9,549.93
| Facility | | $1,584.89 | $4,365.16 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $177.83 / $354.81
| Professional | | $104.71 | $177.83 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $537.03 / $1,479.11
| Facility | | $134.90 | $537.03 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $208.93 / $467.74
| Professional | | $114.82 | $208.93 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,949.84 / $4,677.35
| Facility | | $575.44 | $1,949.84 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $173.78 / $331.13
| Professional | | $102.33 | $173.78 | $331.13 |