- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $7,943.28 / $14,454.40
| Facility | | $144.54 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,174.90 / $2,290.87
| Facility | | $891.25 | $1,174.90 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.13 / $169.82 / $3,715.35
| Facility | | $74.13 | $169.82 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $181.97 / $239.88
| Professional | | $151.36 | $181.97 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $3,162.28 / $8,128.31
| Facility | | $645.65 | $3,162.28 | $8,128.31 |