- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $3,162.28 / $9,549.93
| Facility | | $524.81 | $3,162.28 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $112.20 / $275.42
| Professional | | $91.20 | $112.20 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,981.07 / $9,549.93
| Facility | | $1,737.80 | $3,981.07 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $144.54 / $281.84
| Professional | | $95.50 | $144.54 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $346.74 / $870.96
| Facility | | $186.21 | $346.74 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $173.78 / $389.05
| Professional | | $107.15 | $173.78 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,949.84 / $4,786.30
| Facility | | $575.44 | $1,949.84 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $138.04 / $257.04
| Professional | | $93.33 | $138.04 | $257.04 |