- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $2,137.96 / $7,079.46
| Facility | | $158.49 | $2,137.96 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $125.89 / $257.04
| Professional | | $44.67 | $125.89 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,715.35 / $9,332.54
| Facility | | $1,548.82 | $3,715.35 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $446.68 / $1,071.52
| Professional | | $245.47 | $446.68 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $478.63 / $1,202.26
| Facility | | $354.81 | $478.63 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $123.03 / $186.21
| Professional | | $123.03 | $123.03 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,995.26 / $4,786.30
| Facility | | $645.65 | $1,995.26 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $213.80 / $467.74
| Professional | | $89.13 | $213.80 | $467.74 |