- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $1,862.09 / $6,918.31
| Facility | | $186.21 | $1,862.09 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $173.78 / $467.74
| Professional | | $107.15 | $173.78 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,630.78 / $8,709.64
| Facility | | $1,412.54 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $151.36 / $302.00
| Professional | | $104.71 | $151.36 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $436.52 / $1,318.26
| Facility | | $181.97 | $436.52 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $204.17 / $436.52
| Professional | | $120.23 | $204.17 | $436.52 |
- 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
- $102.33 / $169.82 / $323.59
| Professional | | $102.33 | $169.82 | $323.59 |