- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $4,570.88 / $11,220.18
| Facility | | $257.04 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $186.21 / $380.19
| Professional | | $151.36 | $186.21 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,888.44 / $13,489.63
| Facility | | $3,235.94 | $5,888.44 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $229.09 / $436.52
| Professional | | $151.36 | $229.09 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $416.87 / $1,230.27
| Facility | | $162.18 | $416.87 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $269.15 / $512.86
| Professional | | $169.82 | $269.15 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,202.26 / $3,630.78
| Facility | | $295.12 | $1,202.26 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $223.87 / $398.11
| Professional | | $151.36 | $223.87 | $398.11 |