- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $2,818.38 / $8,709.64
| Facility | | $239.88 | $2,818.38 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $218.78 / $512.86
| Professional | | $120.23 | $218.78 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,365.16 / $10,232.93
| Facility | | $1,621.81 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $223.87 / $436.52
| Professional | | $123.03 | $223.87 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $676.08 / $1,949.84
| Facility | | $158.49 | $676.08 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $251.19 / $549.54
| Professional | | $138.04 | $251.19 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,951.21 / $6,918.31
| Facility | | $1,023.29 | $2,951.21 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $204.17 / $407.38
| Professional | | $117.49 | $204.17 | $407.38 |