- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $251.19 / $2,238.72
| Facility | | $251.19 | $251.19 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $263.03 / $331.13
| Professional | | $173.78 | $263.03 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,122.02 / $2,818.38
| Facility | | $630.96 | $1,122.02 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $467.74
| Facility | | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,318.26
| Professional | | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $562.34 / $2,398.83
| Facility | | $371.54 | $562.34 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $549.54 / $1,584.89
| Professional | | $323.59 | $549.54 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,862.09 / $3,715.35
| Facility | | $1,096.48 | $1,862.09 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $467.74 / $1,023.29
| Professional | | $281.84 | $467.74 | $1,023.29 |