- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $4,265.80 / $10,715.19
| Facility | | $870.96 | $4,265.80 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $478.63 / $1,174.90
| Professional | | $398.11 | $478.63 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $660.69 / $7,244.36
| Facility | | $380.19 | $660.69 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $446.68 / $1,071.52
| Professional | | $251.19 | $446.68 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,096.48 / $3,019.95
| Facility | | $549.54 | $1,096.48 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $645.65 / $1,230.27
| Professional | | $436.52 | $645.65 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,202.26 / $3,715.35
| Facility | | $295.12 | $1,202.26 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $426.58 / $831.76
| Professional | | $288.40 | $426.58 | $831.76 |