- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $2,454.71 / $7,585.78
| Facility | | $186.21 | $2,454.71 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $181.97 / $524.81
| Professional | | $93.33 | $181.97 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,248.07 / $10,964.78
| Facility | | $1,862.09 | $5,248.07 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $177.83 / $346.74
| Professional | | $120.23 | $177.83 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $478.63 / $1,348.96
| Facility | | $151.36 | $478.63 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $204.17 / $457.09
| Professional | | $128.82 | $204.17 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $2,041.74 / $4,897.79
| Facility | | $676.08 | $2,041.74 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $173.78 / $323.59
| Professional | | $114.82 | $173.78 | $323.59 |