- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $3,388.44 / $9,549.93
| Facility | | $281.84 | $3,388.44 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $218.78 / $407.38
| Professional | | $112.20 | $218.78 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,466.84 / $11,748.98
| Facility | | $1,621.81 | $4,466.84 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $229.09 / $467.74
| Professional | | $120.23 | $229.09 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $912.01 / $17,378.01
| Facility | | $186.21 | $912.01 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $245.47 / $602.56
| Professional | | $125.89 | $245.47 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $2,089.30 / $6,025.60
| Facility | | $676.08 | $2,089.30 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $213.80 / $457.09
| Professional | | $112.20 | $213.80 | $457.09 |