- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $2,818.38 / $8,912.51
| Facility | | $263.03 | $2,818.38 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $199.53 / $426.58
| Professional | | $158.49 | $199.53 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,570.88 / $10,232.93
| Facility | | $2,238.72 | $4,570.88 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $245.47 / $446.68
| Professional | | $162.18 | $245.47 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $371.54 / $1,380.38
| Facility | | $100.00 | $371.54 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $269.15 / $562.34
| Professional | | $173.78 | $269.15 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,265.80 / $9,549.93
| Facility | | $1,513.56 | $4,265.80 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $223.87 / $407.38
| Professional | | $151.36 | $223.87 | $407.38 |