- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $1,621.81 / $7,079.46
| Facility | | $208.93 | $1,621.81 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $204.17 / $549.54
| Professional | | $131.83 | $204.17 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $3,630.78 / $8,709.64
| Facility | | $1,380.38 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $199.53 / $363.08
| Professional | | $128.82 | $199.53 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $288.40 / $1,318.26
| Facility | | $151.36 | $288.40 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $223.87 / $467.74
| Professional | | $141.25 | $223.87 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $933.25 / $3,311.31
| Facility | | $169.82 | $933.25 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $190.55 / $346.74
| Professional | | $123.03 | $190.55 | $346.74 |