- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $2,754.23 / $8,511.38
| Facility | | $338.84 | $2,754.23 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $302.00 / $660.69
| Professional | | $144.54 | $302.00 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,570.88 / $12,022.64
| Facility | | $2,041.74 | $4,570.88 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $331.13 / $741.31
| Professional | | $158.49 | $331.13 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $1,023.29 / $3,311.31
| Facility | | $223.87 | $1,023.29 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $354.81 / $794.33
| Professional | | $165.96 | $354.81 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,202.26 / $3,630.78
| Facility | | $295.12 | $1,202.26 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $309.03 / $645.65
| Professional | | $144.54 | $309.03 | $645.65 |