- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $3,548.13 / $10,715.19
| Facility | | $208.93 | $3,548.13 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $208.93 / $407.38
| Professional | | $128.82 | $208.93 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,365.16 / $10,232.93
| Facility | | $1,621.81 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $199.53 / $380.19
| Professional | | $131.83 | $199.53 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $562.34 / $1,621.81
| Facility | | $144.54 | $562.34 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $257.04 / $549.54
| Professional | | $151.36 | $257.04 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,041.74 / $4,897.79
| Facility | | $645.65 | $2,041.74 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $208.93 / $398.11
| Professional | | $125.89 | $208.93 | $398.11 |