- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $2,884.03 / $8,912.51
| Facility | | $380.19 | $2,884.03 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $281.84 / $537.03
| Professional | | $81.28 | $281.84 | $537.03 |
- 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
- $83.18 / $295.12 / $645.65
| Professional | | $83.18 | $295.12 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $295.12 / $1,548.82
| Facility | | $131.83 | $295.12 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $281.84 / $691.83
| Professional | | $93.33 | $281.84 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $954.99 / $3,311.31
| Facility | | $173.78 | $954.99 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $257.04 / $562.34
| Professional | | $79.43 | $257.04 | $562.34 |