- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $2,818.38 / $8,709.64
| Facility | | $275.42 | $2,818.38 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $218.78 / $489.78
| Professional | | $154.88 | $218.78 | $489.78 |
- 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
- $141.25 / $218.78 / $416.87
| Professional | | $141.25 | $218.78 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $537.03 / $1,513.56
| Facility | | $117.49 | $537.03 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $257.04 / $588.84
| Professional | | $154.88 | $257.04 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,071.52 / $3,467.37
| Facility | | $229.09 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $204.17 / $389.05
| Professional | | $144.54 | $204.17 | $389.05 |