- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $3,311.31 / $9,120.11
| Facility | | $309.03 | $3,311.31 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $251.19 / $489.78
| Professional | | $158.49 | $251.19 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $5,248.07 / $12,022.64
| Facility | | $1,778.28 | $5,248.07 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $239.88 / $478.63
| Professional | | $173.78 | $239.88 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $426.58 / $1,479.11
| Facility | | $169.82 | $426.58 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $295.12 / $602.56
| Professional | | $181.97 | $295.12 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,691.53 / $6,606.93
| Facility | | $645.65 | $2,691.53 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $257.04 / $467.74
| Professional | | $158.49 | $257.04 | $467.74 |