- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $1,445.44 / $7,079.46
| Facility | | $181.97 | $1,445.44 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $204.17 / $537.03
| Professional | | $117.49 | $204.17 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,715.35 / $9,549.93
| Facility | | $1,513.56 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $173.78 / $309.03
| Professional | | $114.82 | $173.78 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $380.19 / $1,071.52
| Facility | | $50.12 | $380.19 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $204.17 / $407.38
| Professional | | $131.83 | $204.17 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $1,071.52 / $3,467.37
| Facility | | $234.42 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $169.82 / $302.00
| Professional | | $112.20 | $169.82 | $302.00 |