- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $3,311.31 / $9,120.11
| Facility | | $316.23 | $3,311.31 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $251.19 / $501.19
| Professional | | $131.83 | $251.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,715.35 / $9,120.11
| Facility | | $1,513.56 | $3,715.35 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $269.15 / $524.81
| Professional | | $151.36 | $269.15 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $588.84 / $2,041.74
| Facility | | $208.93 | $588.84 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $302.00 / $691.83
| Professional | | $158.49 | $302.00 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,096.48 / $3,467.37
| Facility | | $295.12 | $1,096.48 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $251.19 / $512.86
| Professional | | $134.90 | $251.19 | $512.86 |