- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $5,248.07 / $8,709.64
| Facility | | $380.19 | $5,248.07 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $407.38 / $2,398.83
| Professional | | $316.23 | $407.38 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $724.44 / $2,137.96
| Professional | | $436.52 | $724.44 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $426.58 / $2,398.83
| Facility | | $354.81 | $426.58 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $758.58 / $1,949.84
| Facility | | $363.08 | $758.58 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $426.58 / $831.76
| Professional | | $331.13 | $426.58 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $2,818.38 / $2,818.38
| Facility | | $2,818.38 | $2,818.38 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $3,981.07 / $4,786.30
| Professional | | $3,981.07 | $3,981.07 | $4,786.30 |