- 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
- $169.82 / $251.19 / $457.09
| Professional | | $169.82 | $251.19 | $457.09 |
- 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
- $169.82 / $245.47 / $478.63
| Professional | | $169.82 | $245.47 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $398.11 / $1,318.26
| Facility | | $275.42 | $398.11 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $295.12 / $616.60
| Professional | | $186.21 | $295.12 | $616.60 |
- 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
- $162.18 / $251.19 / $457.09
| Professional | | $162.18 | $251.19 | $457.09 |