- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.10 / $2,818.38 / $8,709.64
| Facility | | $87.10 | $2,818.38 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $67.61 / $128.82
| Professional | | $37.15 | $67.61 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,715.35 / $9,549.93
| Facility | | $1,513.56 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $72.44 / $141.25
| Professional | | $43.65 | $72.44 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.66 / $218.78 / $549.54
| Facility | | $42.66 | $218.78 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $83.18 / $194.98
| Professional | | $44.67 | $83.18 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $1,071.52 / $3,467.37
| Facility | | $213.80 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $67.61 / $128.82
| Professional | | $38.02 | $67.61 | $128.82 |