- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $2,818.38 / $8,912.51
| Facility | | $331.13 | $2,818.38 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $251.19 / $512.86
| Professional | | $147.91 | $251.19 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,630.78 / $8,709.64
| Facility | | $1,445.44 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $251.19 / $457.09
| Professional | | $144.54 | $251.19 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $707.95 / $2,238.72
| Facility | | $234.42 | $707.95 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $316.23 / $707.95
| Professional | | $173.78 | $316.23 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,041.74 / $4,897.79
| Facility | | $645.65 | $2,041.74 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $251.19 / $501.19
| Professional | | $147.91 | $251.19 | $501.19 |