- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $2,818.38 / $8,709.64
| Facility | | $181.97 | $2,818.38 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $147.91 / $309.03
| Professional | | $85.11 | $147.91 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,715.35 / $9,549.93
| Facility | | $1,513.56 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $151.36 / $323.59
| Professional | | $89.13 | $151.36 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $549.54 / $1,513.56
| Facility | | $147.91 | $549.54 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $177.83 / $407.38
| Professional | | $100.00 | $177.83 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,949.84 / $4,677.35
| Facility | | $562.34 | $1,949.84 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $144.54 / $281.84
| Professional | | $85.11 | $144.54 | $281.84 |