- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $3,388.44 / $9,120.11
| Facility | | $363.08 | $3,388.44 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $288.40 / $537.03
| Professional | | $173.78 | $288.40 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,365.16 / $9,332.54
| Facility | | $1,548.82 | $4,365.16 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $257.04 / $537.03
| Professional | | $162.18 | $257.04 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $501.19 / $1,659.59
| Facility | | $158.49 | $501.19 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $323.59 / $691.83
| Professional | | $186.21 | $323.59 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $933.25 / $3,311.31
| Facility | | $169.82 | $933.25 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $275.42 / $524.81
| Professional | | $162.18 | $275.42 | $524.81 |