- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,071.52 / $2,041.74
| Facility | | $269.15 | $1,071.52 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $309.03 / $446.68
| Professional | | $223.87 | $309.03 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $2,630.27 / $3,548.13
| Facility | | $2,630.27 | $2,630.27 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $338.84 / $489.78
| Professional | | $257.04 | $338.84 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $512.86 / $2,398.83
| Facility | | $489.78 | $512.86 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $354.81 / $537.03
| Professional | | $234.42 | $354.81 | $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
- $213.80 / $316.23 / $501.19
| Professional | | $213.80 | $316.23 | $501.19 |