- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $3,311.31 / $8,511.38
| Facility | | $309.03 | $3,311.31 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $316.23 / $831.76
| Professional | | $151.36 | $316.23 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $5,011.87 / $12,022.64
| Facility | | $1,698.24 | $5,011.87 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $302.00 / $630.96
| Professional | | $162.18 | $302.00 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $1,148.15 / $2,884.03
| Facility | | $257.04 | $1,148.15 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $331.13 / $741.31
| Professional | | $169.82 | $331.13 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,884.03 / $6,456.54
| Facility | | $1,000.00 | $2,884.03 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $275.42 / $537.03
| Professional | | $147.91 | $275.42 | $537.03 |