- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $3,311.31 / $9,332.54
| Facility | | $549.54 | $3,311.31 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $151.36 / $275.42
| Professional | | $120.23 | $151.36 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $131.83 / $1,318.26
| Facility | | $125.89 | $131.83 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $181.97 / $288.40
| Professional | | $120.23 | $181.97 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,454.71 / $4,168.69
| Facility | | $1,513.56 | $2,454.71 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $134.90 / $181.97
| Professional | | $72.44 | $134.90 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,584.89 / $4,168.69
| Facility | | $269.15 | $1,584.89 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $144.54 / $257.04
| Professional | | $102.33 | $144.54 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $131.83 / $186.21
| Professional | | $128.82 | $131.83 | $186.21 |