- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $4,677.35 / $12,022.64
| Facility | | $309.03 | $4,677.35 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $213.80 / $398.11
| Professional | | $177.83 | $213.80 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $9,772.37 / $20,417.38
| Facility | | $2,344.23 | $9,772.37 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $302.00 / $537.03
| Professional | | $177.83 | $302.00 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $489.78 / $1,445.44
| Facility | | $181.97 | $489.78 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $309.03 / $602.56
| Professional | | $190.55 | $309.03 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $263.03 / $457.09
| Professional | | $173.78 | $263.03 | $457.09 |