- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $3,235.94 / $9,332.54
| Facility | | $501.19 | $3,235.94 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $77.62 / $181.97
| Professional | | $64.57 | $77.62 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,570.88 / $10,232.93
| Facility | | $2,238.72 | $4,570.88 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $95.50 / $199.53
| Professional | | $61.66 | $95.50 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $234.42 / $977.24
| Facility | | $117.49 | $234.42 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $112.20 / $245.47
| Professional | | $69.18 | $112.20 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,265.80 / $9,549.93
| Facility | | $1,513.56 | $4,265.80 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $87.10 / $186.21
| Professional | | $60.26 | $87.10 | $186.21 |