- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $3,467.37 / $10,715.19
| Facility | | $181.97 | $3,467.37 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $181.97 / $363.08
| Professional | | $109.65 | $181.97 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,715.35 / $9,549.93
| Facility | | $1,513.56 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $204.17 / $407.38
| Professional | | $120.23 | $204.17 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $602.56 / $1,698.24
| Facility | | $50.12 | $602.56 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $239.88 / $512.86
| Professional | | $131.83 | $239.88 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,754.23 / $6,309.57
| Facility | | $794.33 | $2,754.23 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $199.53 / $389.05
| Professional | | $114.82 | $199.53 | $389.05 |