- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $2,818.38 / $8,912.51
| Facility | | $251.19 | $2,818.38 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $218.78 / $446.68
| Professional | | $125.89 | $218.78 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,265.80 / $10,232.93
| Facility | | $1,513.56 | $4,265.80 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $213.80 / $389.05
| Professional | | $125.89 | $213.80 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $331.13 / $1,230.27
| Facility | | $165.96 | $331.13 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $239.88 / $512.86
| Professional | | $138.04 | $239.88 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,691.53 / $6,606.93
| Facility | | $645.65 | $2,691.53 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $204.17 / $371.54
| Professional | | $120.23 | $204.17 | $371.54 |