- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $3,090.30 / $8,912.51
| Facility | | $269.15 | $3,090.30 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $234.42 / $549.54
| Professional | | $151.36 | $234.42 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,623.41 / $13,489.63
| Facility | | $1,995.26 | $5,623.41 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $239.88 / $489.78
| Professional | | $158.49 | $239.88 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $794.33 / $1,949.84
| Facility | | $251.19 | $794.33 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $295.12 / $645.65
| Professional | | $181.97 | $295.12 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,265.80 / $9,772.37
| Facility | | $1,584.89 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $239.88 / $457.09
| Professional | | $154.88 | $239.88 | $457.09 |