- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $2,818.38 / $8,709.64
| Facility | | $223.87 | $2,818.38 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $169.82 / $363.08
| Professional | | $104.71 | $169.82 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,248.07 / $12,022.64
| Facility | | $1,862.09 | $5,248.07 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $177.83 / $363.08
| Professional | | $102.33 | $177.83 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $707.95 / $1,778.28
| Facility | | $208.93 | $707.95 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $208.93 / $467.74
| Professional | | $117.49 | $208.93 | $467.74 |
- 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
- $102.33 / $173.78 / $338.84
| Professional | | $102.33 | $173.78 | $338.84 |