- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $3,715.35 / $9,549.93
| Facility | | $724.44 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $165.96 / $309.03
| Professional | | $141.25 | $165.96 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,897.79 / $13,489.63
| Facility | | $1,621.81 | $4,897.79 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $186.21 / $331.13
| Professional | | $134.90 | $186.21 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $575.44 / $1,819.70
| Facility | | $257.04 | $575.44 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $229.09 / $446.68
| Professional | | $154.88 | $229.09 | $446.68 |
- 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
- $131.83 / $186.21 / $331.13
| Professional | | $131.83 | $186.21 | $331.13 |