- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $2,398.83 / $8,317.64
| Facility | | $234.42 | $2,398.83 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $213.80 / $616.60
| Professional | | $123.03 | $213.80 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,715.35 / $9,549.93
| Facility | | $1,513.56 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $223.87 / $426.58
| Professional | | $138.04 | $223.87 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $602.56 / $1,778.28
| Facility | | $120.23 | $602.56 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $257.04 / $524.81
| Professional | | $144.54 | $257.04 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,096.48 / $3,467.37
| Facility | | $295.12 | $1,096.48 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $204.17 / $389.05
| Professional | | $123.03 | $204.17 | $389.05 |