- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $933.25 / $7,244.36
| Facility | | $199.53 | $933.25 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $489.78 / $1,096.48
| Professional | | $173.78 | $489.78 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $234.42 / $234.42
| Professional | | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $8,317.64 / $10,471.29
| Facility | | $2,344.23 | $8,317.64 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $537.03 / $1,621.81
| Professional | | $218.78 | $537.03 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $173.78 / $199.53
| Facility | | $165.96 | $173.78 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $645.65 / $1,778.28
| Professional | | $186.21 | $645.65 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $6,025.60 / $10,715.19
| Facility | | $2,884.03 | $6,025.60 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $489.78 / $1,348.96
| Professional | | $173.78 | $489.78 | $1,348.96 |