- 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 / $218.78 / $436.52
| Professional | | $177.83 | $218.78 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $7,943.28 / $16,218.10
| Facility | | $2,187.76 | $7,943.28 | $16,218.10 |
- 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
- $281.84 / $524.81 / $1,445.44
| Facility | | $281.84 | $524.81 | $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 |