- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $2,511.89 / $7,762.47
| Facility | | $257.04 | $2,511.89 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $229.09 / $426.58
| Professional | | $112.20 | $229.09 | $426.58 |
- 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
- $102.33 / $204.17 / $467.74
| Professional | | $102.33 | $204.17 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $363.08 / $1,905.46
| Facility | | $131.83 | $363.08 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $269.15 / $575.44
| Professional | | $138.04 | $269.15 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,949.84 / $4,677.35
| Facility | | $588.84 | $1,949.84 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $245.47 / $478.63
| Professional | | $125.89 | $245.47 | $478.63 |