- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $3,162.28 / $9,332.54
| Facility | | $524.81 | $3,162.28 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $85.11 / $194.98
| Professional | | $67.61 | $85.11 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,570.88 / $13,489.63
| Facility | | $1,621.81 | $4,570.88 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $97.72 / $208.93
| Professional | | $66.07 | $97.72 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $234.42 / $1,318.26
| Facility | | $102.33 | $234.42 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $120.23 / $269.15
| Professional | | $75.86 | $120.23 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,951.21 / $6,760.83
| Facility | | $1,023.29 | $2,951.21 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $93.33 / $177.83
| Professional | | $64.57 | $93.33 | $177.83 |