- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $660.69 / $7,413.10
| Facility | | $194.98 | $660.69 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $302.00 / $707.95
| Professional | | $131.83 | $302.00 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,630.78 / $8,709.64
| Facility | | $1,445.44 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $213.80 / $426.58
| Professional | | $117.49 | $213.80 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $758.58 / $2,630.27
| Facility | | $50.12 | $758.58 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $316.23 / $741.31
| Professional | | $147.91 | $316.23 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $1,071.52 / $3,467.37
| Facility | | $204.17 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $251.19 / $512.86
| Professional | | $123.03 | $251.19 | $512.86 |