- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $3,715.35 / $10,715.19
| Facility | | $223.87 | $3,715.35 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $229.09 / $436.52
| Professional | | $128.82 | $229.09 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,786.30 / $10,471.29
| Facility | | $1,819.70 | $4,786.30 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $213.80 / $407.38
| Professional | | $125.89 | $213.80 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $295.12 / $1,995.26
| Facility | | $138.04 | $295.12 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $281.84 / $616.60
| Professional | | $154.88 | $281.84 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $1,071.52 / $3,467.37
| Facility | | $223.87 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $229.09 / $446.68
| Professional | | $128.82 | $229.09 | $446.68 |