- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $2,238.72 / $7,762.47
| Facility | | $120.23 | $2,238.72 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $128.82 / $363.08
| Professional | | $70.79 | $128.82 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,365.16 / $9,549.93
| Facility | | $1,548.82 | $4,365.16 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $117.49 / $239.88
| Professional | | $70.79 | $117.49 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $457.09 / $1,318.26
| Facility | | $141.25 | $457.09 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $138.04 / $309.03
| Professional | | $81.28 | $138.04 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,949.84 / $4,677.35
| Facility | | $575.44 | $1,949.84 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $114.82 / $218.78
| Professional | | $69.18 | $114.82 | $218.78 |