- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $3,388.44 / $9,120.11
| Facility | | $144.54 | $3,388.44 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $107.15 / $218.78
| Professional | | $70.79 | $107.15 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,128.61 / $11,220.18
| Facility | | $1,819.70 | $5,128.61 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $128.82 / $239.88
| Professional | | $81.28 | $128.82 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $457.09 / $2,344.23
| Facility | | $134.90 | $457.09 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $144.54 / $316.23
| Professional | | $89.13 | $144.54 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,365.16 / $10,715.19
| Facility | | $1,548.82 | $4,365.16 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $117.49 / $218.78
| Professional | | $77.62 | $117.49 | $218.78 |