- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $3,311.31 / $9,120.11
| Facility | | $331.13 | $3,311.31 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $245.47 / $549.54
| Professional | | $177.83 | $245.47 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,715.35 / $8,709.64
| Facility | | $1,513.56 | $3,715.35 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $239.88 / $478.63
| Professional | | $173.78 | $239.88 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $630.96 / $1,862.09
| Facility | | $269.15 | $630.96 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $309.03 / $676.08
| Professional | | $199.53 | $309.03 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,949.84 / $4,677.35
| Facility | | $645.65 | $1,949.84 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $257.04 / $478.63
| Professional | | $169.82 | $257.04 | $478.63 |