- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $3,162.28 / $8,912.51
| Facility | | $537.03 | $3,162.28 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $128.82 / $288.40
| Professional | | $107.15 | $128.82 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,786.30 / $13,803.84
| Facility | | $1,513.56 | $4,786.30 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $128.82 / $239.88
| Professional | | $95.50 | $128.82 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $575.44 / $6,309.57
| Facility | | $199.53 | $575.44 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $169.82 / $363.08
| Professional | | $109.65 | $169.82 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,128.61 / $12,882.50
| Facility | | $1,348.96 | $5,128.61 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $134.90 / $245.47
| Professional | | $97.72 | $134.90 | $245.47 |