- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $1,348.96 / $6,918.31
| Facility | | $162.18 | $1,348.96 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $177.83 / $457.09
| Professional | | $102.33 | $177.83 | $457.09 |
- 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
- $102.33 / $181.97 / $331.13
| Professional | | $102.33 | $181.97 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $245.47 / $1,380.38
| Facility | | $107.15 | $245.47 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $194.98 / $457.09
| Professional | | $112.20 | $194.98 | $457.09 |
- 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
- $95.50 / $154.88 / $302.00
| Professional | | $95.50 | $154.88 | $302.00 |