- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $2,089.30 / $8,317.64
| Facility | | $186.21 | $2,089.30 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $229.09 / $741.31
| Professional | | $114.82 | $229.09 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $1,023.29 / $4,677.35
| Facility | | $162.18 | $1,023.29 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $208.93 / $380.19
| Professional | | $141.25 | $208.93 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $354.81 / $1,023.29
| Facility | | $104.71 | $354.81 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $218.78 / $407.38
| Professional | | $117.49 | $218.78 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,148.15 / $3,467.37
| Facility | | $302.00 | $1,148.15 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $177.83 / $323.59
| Professional | | $97.72 | $177.83 | $323.59 |