- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $4,265.80 / $7,079.46
| Facility | | $218.78 | $4,265.80 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $104.71 / $208.93
| Professional | | $44.67 | $104.71 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,162.28 / $11,748.98
| Facility | | $2,137.96 | $3,162.28 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $107.15 / $125.89
| Professional | | $57.54 | $107.15 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $50.12
| Facility | | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $147.91 / $257.04
| Professional | | $69.18 | $147.91 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $199.53 / $208.93
| Professional | | $199.53 | $199.53 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $4,570.88 / $9,332.54
| Facility | | $1,905.46 | $4,570.88 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $112.20 / $257.04
| Professional | | $50.12 | $112.20 | $257.04 |