- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $3,162.28 / $9,120.11
| Facility | | $257.04 | $3,162.28 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $288.40 / $691.83
| Professional | | $131.83 | $288.40 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $5,011.87 / $12,022.64
| Facility | | $1,698.24 | $5,011.87 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $295.12 / $602.56
| Professional | | $144.54 | $295.12 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $933.25 / $2,290.87
| Facility | | $213.80 | $933.25 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $316.23 / $724.44
| Professional | | $147.91 | $316.23 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,265.80 / $9,549.93
| Facility | | $1,513.56 | $4,265.80 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $269.15 / $549.54
| Professional | | $131.83 | $269.15 | $549.54 |