- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $2,951.21 / $8,709.64
| Facility | | $371.54 | $2,951.21 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $269.15 / $489.78
| Professional | | $128.82 | $269.15 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,265.80 / $10,232.93
| Facility | | $1,513.56 | $4,265.80 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $275.42 / $724.44
| Professional | | $169.82 | $275.42 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $933.25 / $2,754.23
| Facility | | $223.87 | $933.25 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $316.23 / $691.83
| Professional | | $147.91 | $316.23 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $2,630.27 / $6,309.57
| Facility | | $660.69 | $2,630.27 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $263.03 / $537.03
| Professional | | $125.89 | $263.03 | $537.03 |