- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,445.44 / $2,511.89
| Facility | | $436.52 | $1,445.44 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $1,202.26 / $1,862.09
| Professional | | $346.74 | $1,202.26 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $602.56 / $645.65
| Professional | | $524.81 | $602.56 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,019.95 / $4,168.69
| Facility | | $3,019.95 | $3,019.95 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $457.09 / $1,778.28
| Professional | | $346.74 | $457.09 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $691.83 / $2,691.53
| Professional | | $363.08 | $691.83 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $691.83
| Professional | | $602.56 | $602.56 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,951.21 / $8,912.51
| Facility | | $1,230.27 | $2,951.21 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $1,318.26 / $2,630.27
| Professional | | $354.81 | $1,318.26 | $2,630.27 |