- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,445.44 / $2,238.72
| Facility | | $758.58 | $1,445.44 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $380.19 / $776.25
| Professional | | $234.42 | $380.19 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,548.13 / $4,786.30
| Facility | | $2,951.21 | $3,548.13 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $389.05 / $501.19
| Professional | | $275.42 | $389.05 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $426.58
| Facility | | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $389.05 / $851.14
| Professional | | $245.47 | $389.05 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,818.38 / $4,073.80
| Facility | | $831.76 | $2,818.38 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $331.13 / $602.56
| Professional | | $208.93 | $331.13 | $602.56 |