- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $4,897.79 / $11,220.18
| Facility | | $354.81 | $4,897.79 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $302.00 / $537.03
| Professional | | $208.93 | $302.00 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $4,466.84 / $8,709.64
| Facility | | $2,137.96 | $4,466.84 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $331.13 / $524.81
| Professional | | $213.80 | $331.13 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $389.05 / $602.56
| Facility | | $263.03 | $389.05 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $323.59 / $489.78
| Professional | | $223.87 | $323.59 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $2,137.96 / $5,754.40
| Facility | | $331.13 | $2,137.96 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $295.12 / $501.19
| Professional | | $208.93 | $295.12 | $501.19 |