- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $1,202.26 / $6,456.54
| Facility | | $263.03 | $1,202.26 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $295.12 / $758.58
| Professional | | $165.96 | $295.12 | $758.58 |
- 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
- $173.78 / $281.84 / $562.34
| Professional | | $173.78 | $281.84 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $977.24 / $2,754.23
| Facility | | $50.12 | $977.24 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $338.84 / $741.31
| Professional | | $199.53 | $338.84 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,122.02 / $3,467.37
| Facility | | $302.00 | $1,122.02 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $275.42 / $512.86
| Professional | | $169.82 | $275.42 | $512.86 |