- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $2,818.38 / $8,912.51
| Facility | | $223.87 | $2,818.38 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $158.49 / $380.19
| Professional | | $95.50 | $158.49 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,715.35 / $9,549.93
| Facility | | $1,513.56 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $173.78 / $363.08
| Professional | | $109.65 | $173.78 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $602.56 / $1,778.28
| Facility | | $50.12 | $602.56 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $204.17 / $467.74
| Professional | | $112.20 | $204.17 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $1,202.26 / $3,548.13
| Facility | | $316.23 | $1,202.26 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $169.82 / $323.59
| Professional | | $100.00 | $169.82 | $323.59 |