- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $2,884.03 / $8,511.38
| Facility | | $309.03 | $2,884.03 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $288.40 / $776.25
| Professional | | $177.83 | $288.40 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,365.16 / $9,549.93
| Facility | | $1,621.81 | $4,365.16 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $302.00 / $588.84
| Professional | | $181.97 | $302.00 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $1,096.48 / $2,754.23
| Facility | | $354.81 | $1,096.48 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $338.84 / $758.58
| Professional | | $199.53 | $338.84 | $758.58 |
- 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
- $181.97 / $288.40 / $549.54
| Professional | | $181.97 | $288.40 | $549.54 |