- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $2,398.83 / $8,317.64
| Facility | | $177.83 | $2,398.83 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $190.55 / $549.54
| Professional | | $72.44 | $190.55 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,981.07 / $10,715.19
| Facility | | $1,621.81 | $3,981.07 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $199.53 / $446.68
| Professional | | $77.62 | $199.53 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $363.08 / $36,307.81
| Facility | | $79.43 | $363.08 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $177.83 / $398.11
| Professional | | $81.28 | $177.83 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $1,148.15 / $3,630.78
| Facility | | $245.47 | $1,148.15 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $173.78 / $363.08
| Professional | | $74.13 | $173.78 | $363.08 |