- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $4,570.88 / $8,511.38
| Facility | | $281.84 | $4,570.88 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $177.83 / $380.19
| Professional | | $81.28 | $177.83 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,162.28 / $10,471.29
| Facility | | $2,137.96 | $3,162.28 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $138.04 / $204.17
| Professional | | $95.50 | $138.04 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $186.21 / $302.00
| Professional | | $112.20 | $186.21 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $186.21 / $186.21
| Professional | | $177.83 | $186.21 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $4,570.88 / $9,332.54
| Facility | | $1,905.46 | $4,570.88 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $147.91 / $245.47
| Professional | | $93.33 | $147.91 | $245.47 |