- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $794.33 / $2,041.74
| Facility | | $295.12 | $794.33 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $316.23 / $467.74
| Professional | | $208.93 | $316.23 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,412.54 / $1,949.84
| Facility | | $1,412.54 | $1,412.54 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $309.03 / $489.78
| Professional | | $234.42 | $309.03 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $512.86 / $1,737.80
| Facility | | $208.93 | $512.86 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $346.74 / $537.03
| Professional | | $223.87 | $346.74 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,288.25 / $4,365.16
| Facility | | $537.03 | $1,288.25 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $331.13 / $512.86
| Professional | | $208.93 | $331.13 | $512.86 |