- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $3,162.28 / $9,332.54
| Facility | | $524.81 | $3,162.28 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $89.13 / $204.17
| Professional | | $75.86 | $89.13 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,677.35 / $10,232.93
| Facility | | $2,238.72 | $4,677.35 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $123.03 / $218.78
| Professional | | $75.86 | $123.03 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $218.78 / $676.08
| Facility | | $83.18 | $218.78 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $134.90 / $288.40
| Professional | | $85.11 | $134.90 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $107.15 / $190.55
| Professional | | $70.79 | $107.15 | $190.55 |