- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $4,466.84 / $10,471.29
| Facility | | $177.83 | $4,466.84 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $234.42 / $691.83
| Professional | | $102.33 | $234.42 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $269.15 / $707.95
| Professional | | $109.65 | $269.15 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $478.63 / $758.58
| Professional | | $186.21 | $478.63 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $416.87 / $660.69
| Facility | | $269.15 | $416.87 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $309.03 / $588.84
| Professional | | $83.18 | $309.03 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,884.03 / $7,762.47
| Facility | | $1,318.26 | $2,884.03 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $213.80 / $549.54
| Professional | | $81.28 | $213.80 | $549.54 |