- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $4,570.88 / $8,511.38
| Facility | | $245.47 | $4,570.88 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $162.18 / $489.78
| Professional | | $63.10 | $162.18 | $489.78 |
- 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
- $70.79 / $114.82 / $190.55
| Professional | | $70.79 | $114.82 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $173.78 / $309.03
| Professional | | $89.13 | $173.78 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $169.82 / $169.82
| Professional | | $162.18 | $169.82 | $169.82 |
- 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
- $61.66 / $114.82 / $213.80
| Professional | | $61.66 | $114.82 | $213.80 |