- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,047.13 / $7,762.47
| Facility | | $436.52 | $1,047.13 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $338.84 / $616.60
| Professional | | $288.40 | $338.84 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $467.74 / $1,122.02
| Professional | | $275.42 | $467.74 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $95.50
| Professional | | $32.36 | $33.11 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $426.58 / $691.83
| Facility | | $288.40 | $426.58 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $489.78 / $758.58
| Professional | | $323.59 | $489.78 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $6,606.93 / $14,125.38
| Facility | | $645.65 | $6,606.93 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $467.74 / $645.65
| Professional | | $338.84 | $467.74 | $645.65 |