- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $2,691.53 / $9,120.11
| Facility | | $257.04 | $2,691.53 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $234.42 / $588.84
| Professional | | $134.90 | $234.42 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $4,897.79 / $13,803.84
| Facility | | $2,137.96 | $4,897.79 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $229.09 / $436.52
| Professional | | $131.83 | $229.09 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $776.25 / $6,918.31
| Facility | | $245.47 | $776.25 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $288.40 / $660.69
| Professional | | $158.49 | $288.40 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,623.41 / $12,302.69
| Facility | | $1,949.84 | $5,623.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $245.47 / $524.81
| Professional | | $134.90 | $245.47 | $524.81 |