- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $3,162.28 / $9,120.11
| Facility | | $537.03 | $3,162.28 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $173.78 / $389.05
| Professional | | $141.25 | $173.78 | $389.05 |
- 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
- $138.04 / $208.93 / $389.05
| Professional | | $138.04 | $208.93 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $346.74 / $1,122.02
| Facility | | $151.36 | $346.74 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $251.19 / $549.54
| Professional | | $158.49 | $251.19 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,122.02 / $3,467.37
| Facility | | $295.12 | $1,122.02 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $190.55 / $354.81
| Professional | | $134.90 | $190.55 | $354.81 |