- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $2,818.38 / $8,912.51
| Facility | | $354.81 | $2,818.38 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $251.19 / $524.81
| Professional | | $190.55 | $251.19 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,715.35 / $9,332.54
| Facility | | $1,621.81 | $3,715.35 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $323.59 / $588.84
| Professional | | $208.93 | $323.59 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $660.69 / $2,238.72
| Facility | | $251.19 | $660.69 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $354.81 / $741.31
| Professional | | $229.09 | $354.81 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $1,071.52 / $3,467.37
| Facility | | $245.47 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $295.12 / $537.03
| Professional | | $204.17 | $295.12 | $537.03 |