- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $2,041.74 / $7,762.47
| Facility | | $190.55 | $2,041.74 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $239.88 / $602.56
| Professional | | $134.90 | $239.88 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,365.16 / $9,549.93
| Facility | | $1,548.82 | $4,365.16 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $199.53 / $354.81
| Professional | | $128.82 | $199.53 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $501.19 / $1,479.11
| Facility | | $75.86 | $501.19 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $223.87 / $467.74
| Professional | | $144.54 | $223.87 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $1,096.48 / $3,467.37
| Facility | | $245.47 | $1,096.48 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $186.21 / $338.84
| Professional | | $128.82 | $186.21 | $338.84 |