- 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
- $107.15 / $131.83 / $331.13
| Professional | | $107.15 | $131.83 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,630.78 / $8,709.64
| Facility | | $1,445.44 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $169.82 / $323.59
| Professional | | $114.82 | $169.82 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $371.54 / $1,318.26
| Facility | | $194.98 | $371.54 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $204.17 / $426.58
| Professional | | $128.82 | $204.17 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $1,071.52 / $3,467.37
| Facility | | $239.88 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $162.18 / $295.12
| Professional | | $109.65 | $162.18 | $295.12 |