- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $2,344.23 / $4,897.79
| Facility | | $169.82 | $2,344.23 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $181.97 / $275.42
| Professional | | $151.36 | $181.97 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $14,125.38 / $19,054.61
| Facility | | $6,456.54 | $14,125.38 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $147.91 / $239.88
| Professional | | $125.89 | $147.91 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $162.18 / $173.78
| Facility | | $147.91 | $162.18 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $208.93 / $269.15
| Professional | | $154.88 | $208.93 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,754.40 / $12,022.64
| Facility | | $1,412.54 | $5,754.40 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $208.93 / $338.84
| Professional | | $147.91 | $208.93 | $338.84 |