- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $1,949.84 / $7,762.47
| Facility | | $186.21 | $1,949.84 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $257.04 / $602.56
| Professional | | $102.33 | $257.04 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,630.78 / $8,709.64
| Facility | | $1,445.44 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $177.83 / $426.58
| Professional | | $102.33 | $177.83 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $1,148.15 / $3,162.28
| Facility | | $128.82 | $1,148.15 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $281.84 / $812.83
| Professional | | $117.49 | $281.84 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $1,071.52 / $3,467.37
| Facility | | $199.53 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $239.88 / $575.44
| Professional | | $102.33 | $239.88 | $575.44 |