- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $2,818.38 / $8,912.51
| Facility | | $245.47 | $2,818.38 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $173.78 / $389.05
| Professional | | $123.03 | $173.78 | $389.05 |
- 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
- $120.23 / $181.97 / $346.74
| Professional | | $120.23 | $181.97 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $281.84 / $1,318.26
| Facility | | $91.20 | $281.84 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $229.09 / $478.63
| Professional | | $147.91 | $229.09 | $478.63 |
- 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
- $123.03 / $190.55 / $346.74
| Professional | | $123.03 | $190.55 | $346.74 |