- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $3,235.94 / $8,912.51
| Facility | | $331.13 | $3,235.94 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $269.15 / $549.54
| Professional | | $144.54 | $269.15 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,715.35 / $8,912.51
| Facility | | $1,513.56 | $3,715.35 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $213.80 / $446.68
| Professional | | $114.82 | $213.80 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $645.65 / $2,454.71
| Facility | | $208.93 | $645.65 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $331.13 / $776.25
| Professional | | $154.88 | $331.13 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,148.15 / $3,467.37
| Facility | | $309.03 | $1,148.15 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $257.04 / $537.03
| Professional | | $131.83 | $257.04 | $537.03 |