- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $2,187.76 / $7,943.28
| Facility | | $245.47 | $2,187.76 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $208.93 / $549.54
| Professional | | $114.82 | $208.93 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,630.78 / $8,912.51
| Facility | | $1,513.56 | $3,630.78 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $234.42 / $457.09
| Professional | | $147.91 | $234.42 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $870.96 / $2,187.76
| Facility | | $269.15 | $870.96 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $269.15 / $588.84
| Professional | | $154.88 | $269.15 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,122.02 / $3,467.37
| Facility | | $302.00 | $1,122.02 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $229.09 / $426.58
| Professional | | $138.04 | $229.09 | $426.58 |