- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $3,235.94 / $8,912.51
| Facility | | $295.12 | $3,235.94 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $257.04 / $524.81
| Professional | | $162.18 | $257.04 | $524.81 |
- 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 / $478.63
| Professional | | $162.18 | $257.04 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $331.13 / $2,089.30
| Facility | | $141.25 | $331.13 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $316.23 / $676.08
| Professional | | $190.55 | $316.23 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $1,071.52 / $3,467.37
| Facility | | $223.87 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $263.03 / $501.19
| Professional | | $162.18 | $263.03 | $501.19 |