- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $2,570.40 / $8,317.64
| Facility | | $158.49 | $2,570.40 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $141.25 / $309.03
| Professional | | $95.50 | $141.25 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,715.35 / $8,709.64
| Facility | | $1,513.56 | $3,715.35 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $151.36 / $295.12
| Professional | | $104.71 | $151.36 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $416.87 / $1,380.38
| Facility | | $134.90 | $416.87 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $181.97 / $389.05
| Professional | | $114.82 | $181.97 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $1,071.52 / $3,467.37
| Facility | | $213.80 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $147.91 / $275.42
| Professional | | $97.72 | $147.91 | $275.42 |