- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $3,388.44 / $9,120.11
| Facility | | $371.54 | $3,388.44 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $275.42 / $537.03
| Professional | | $147.91 | $275.42 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,623.41 / $13,489.63
| Facility | | $1,995.26 | $5,623.41 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $295.12 / $588.84
| Professional | | $177.83 | $295.12 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $912.01 / $2,290.87
| Facility | | $251.19 | $912.01 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $338.84 / $758.58
| Professional | | $177.83 | $338.84 | $758.58 |
- 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
- $147.91 / $281.84 / $562.34
| Professional | | $147.91 | $281.84 | $562.34 |