- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $1,412.54 / $2,041.74
| Facility | | $186.21 | $1,412.54 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $144.54 / $199.53
| Professional | | $128.82 | $144.54 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $5,248.07 / $7,079.46
| Facility | | $5,248.07 | $5,248.07 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $131.83 / $173.78
| Professional | | $131.83 | $131.83 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $3,090.30
| Facility | | $3,090.30 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $257.04 / $426.58
| Professional | | $208.93 | $257.04 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,495.41 / $11,481.54
| Facility | | $2,089.30 | $5,495.41 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $177.83 / $281.84
| Professional | | $123.03 | $177.83 | $281.84 |