- 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
- $177.83 / $251.19 / $478.63
| Professional | | $177.83 | $251.19 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $3,630.78 / $8,709.64
| Facility | | $1,380.38 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $251.19 / $478.63
| Professional | | $177.83 | $251.19 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $457.09 / $1,318.26
| Facility | | $316.23 | $457.09 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $295.12 / $602.56
| Professional | | $190.55 | $295.12 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $1,023.29 / $3,311.31
| Facility | | $173.78 | $1,023.29 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $251.19 / $457.09
| Professional | | $165.96 | $251.19 | $457.09 |