- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $2,818.38 / $8,709.64
| Facility | | $269.15 | $2,818.38 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $204.17 / $446.68
| Professional | | $128.82 | $204.17 | $446.68 |
- 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
- $134.90 / $213.80 / $426.58
| Professional | | $134.90 | $213.80 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $831.76 / $2,041.74
| Facility | | $251.19 | $831.76 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $251.19 / $549.54
| Professional | | $144.54 | $251.19 | $549.54 |
- 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
- $128.82 / $208.93 / $398.11
| Professional | | $128.82 | $208.93 | $398.11 |