- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $3,162.28 / $9,120.11
| Facility | | $446.68 | $3,162.28 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $245.47 / $489.78
| Professional | | $147.91 | $245.47 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $575.44 / $4,786.30
| Facility | | $154.88 | $575.44 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $407.38 / $794.33
| Professional | | $190.55 | $407.38 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $1,258.93 / $3,467.37
| Facility | | $275.42 | $1,258.93 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $275.42 / $436.52
| Professional | | $245.47 | $275.42 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,202.26 / $3,548.13
| Facility | | $302.00 | $1,202.26 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $416.87 / $851.14
| Professional | | $194.98 | $416.87 | $851.14 |