- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $2,884.03 / $8,912.51
| Facility | | $295.12 | $2,884.03 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $234.42 / $489.78
| Professional | | $147.91 | $234.42 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,890.45 / $9,549.93
| Facility | | $1,621.81 | $3,890.45 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $257.04 / $501.19
| Professional | | $162.18 | $257.04 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $309.03 / $1,905.46
| Facility | | $147.91 | $309.03 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $288.40 / $630.96
| Professional | | $173.78 | $288.40 | $630.96 |
- 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
- $147.91 / $234.42 / $457.09
| Professional | | $147.91 | $234.42 | $457.09 |