- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $2,041.74 / $7,244.36
| Facility | | $208.93 | $2,041.74 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $218.78 / $524.81
| Professional | | $97.72 | $218.78 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,630.78 / $8,709.64
| Facility | | $1,412.54 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $190.55 / $380.19
| Professional | | $87.10 | $190.55 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $501.19 / $1,318.26
| Facility | | $169.82 | $501.19 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $218.78 / $501.19
| Professional | | $104.71 | $218.78 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $1,819.70 / $4,570.88
| Facility | | $446.68 | $1,819.70 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $177.83 / $354.81
| Professional | | $89.13 | $177.83 | $354.81 |