- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $3,388.44 / $9,120.11
| Facility | | $275.42 | $3,388.44 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $208.93 / $380.19
| Professional | | $117.49 | $208.93 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,677.35 / $13,489.63
| Facility | | $1,698.24 | $4,677.35 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $213.80 / $426.58
| Professional | | $125.89 | $213.80 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $660.69 / $1,949.84
| Facility | | $190.55 | $660.69 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $257.04 / $562.34
| Professional | | $134.90 | $257.04 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,019.95 / $6,918.31
| Facility | | $1,023.29 | $3,019.95 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $208.93 / $407.38
| Professional | | $114.82 | $208.93 | $407.38 |