- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,454.71 / $6,606.93
| Facility | | $758.58 | $2,454.71 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $141.25 / $239.88
| Professional | | $114.82 | $141.25 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $173.78 / $208.93
| Professional | | $131.83 | $173.78 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $812.83 / $3,890.45
| Facility | | $147.91 | $812.83 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $154.88 / $1,949.84
| Professional | | $114.82 | $154.88 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,318.26 / $2,691.53
| Facility | | $371.54 | $1,318.26 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $138.04 / $194.98
| Professional | | $109.65 | $138.04 | $194.98 |