- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $2,089.30 / $7,762.47
| Facility | | $194.98 | $2,089.30 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $181.97 / $457.09
| Professional | | $112.20 | $181.97 | $457.09 |
- 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
- $100.00 / $169.82 / $316.23
| Professional | | $100.00 | $169.82 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $281.84 / $1,380.38
| Facility | | $120.23 | $281.84 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $234.42 / $512.86
| Professional | | $131.83 | $234.42 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,949.84 / $4,786.30
| Facility | | $575.44 | $1,949.84 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $186.21 / $363.08
| Professional | | $109.65 | $186.21 | $363.08 |