- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $3,388.44 / $8,912.51
| Facility | | $281.84 | $3,388.44 | $8,912.51 |
- 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
- $1,513.56 / $3,715.35 / $8,912.51
| Facility | | $1,513.56 | $3,715.35 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $218.78 / $426.58
| Professional | | $134.90 | $218.78 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $676.08 / $1,862.09
| Facility | | $186.21 | $676.08 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $257.04 / $562.34
| Professional | | $144.54 | $257.04 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $1,071.52 / $3,467.37
| Facility | | $213.80 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $213.80 / $416.87
| Professional | | $125.89 | $213.80 | $416.87 |