- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $2,570.40 / $7,943.28
| Facility | | $204.17 | $2,570.40 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $199.53 / $524.81
| Professional | | $120.23 | $199.53 | $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
- $141.25 / $208.93 / $398.11
| Professional | | $141.25 | $208.93 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $741.31 / $1,819.70
| Facility | | $269.15 | $741.31 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $234.42 / $524.81
| Professional | | $151.36 | $234.42 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,884.03 / $6,309.57
| Facility | | $1,023.29 | $2,884.03 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $199.53 / $371.54
| Professional | | $131.83 | $199.53 | $371.54 |