- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $2,691.53 / $8,511.38
| Facility | | $239.88 | $2,691.53 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $245.47 / $575.44
| Professional | | $144.54 | $245.47 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $199.53 / $3,715.35
| Facility | | $151.36 | $199.53 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $218.78 / $457.09
| Professional | | $141.25 | $218.78 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $371.54 / $1,862.09
| Facility | | $134.90 | $371.54 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $275.42 / $660.69
| Professional | | $158.49 | $275.42 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $3,162.28 / $10,232.93
| Facility | | $537.03 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $204.17 / $407.38
| Professional | | $131.83 | $204.17 | $407.38 |