- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.28 / $1,548.82 / $6,165.95
| Facility | | $81.28 | $1,548.82 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $87.10 / $251.19
| Professional | | $72.44 | $87.10 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,365.16 / $10,232.93
| Facility | | $1,698.24 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $112.20 / $208.93
| Professional | | $72.44 | $112.20 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $295.12 / $724.44
| Facility | | $213.80 | $295.12 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $239.88 / $346.74
| Professional | | $138.04 | $239.88 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,884.03 / $6,309.57
| Facility | | $1,023.29 | $2,884.03 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $102.33 / $190.55
| Professional | | $72.44 | $102.33 | $190.55 |