- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $2,454.71 / $7,943.28
| Facility | | $229.09 | $2,454.71 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $199.53 / $467.74
| Professional | | $151.36 | $199.53 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,365.16 / $9,549.93
| Facility | | $1,548.82 | $4,365.16 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $234.42 / $416.87
| Professional | | $162.18 | $234.42 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $549.54 / $1,584.89
| Facility | | $50.12 | $549.54 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $263.03 / $537.03
| Professional | | $173.78 | $263.03 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,949.84 / $4,677.35
| Facility | | $537.03 | $1,949.84 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $218.78 / $398.11
| Professional | | $147.91 | $218.78 | $398.11 |