- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,495.41 / $10,715.19
| Facility | | $2,290.87 | $5,495.41 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $123.03 / $478.63
| Professional | | $58.88 | $123.03 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $123.03 / $295.12
| Professional | | $67.61 | $123.03 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $169.82 / $194.98
| Professional | | $125.89 | $169.82 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,290.87 / $3,548.13
| Facility | | $1,412.54 | $2,290.87 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $120.23 / $218.78
| Professional | | $50.12 | $120.23 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,715.35 / $7,762.47
| Facility | | $1,862.09 | $3,715.35 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.48 / $79.43 / $190.55
| Professional | | $35.48 | $79.43 | $190.55 |