- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,710.18 / $4,301.06 / $6,371.32
| Facility | | $3,710.18 | $4,301.06 | $6,371.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.36 / $257.41 / $526.04
| Professional | | $231.36 | $257.41 | $526.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $259.47 / $288.33 / $314.14
| Facility | | $259.47 | $288.33 | $314.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.24 / $279.24 / $279.24
| Professional | | $279.24 | $279.24 | $279.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $277.49 / $277.49 / $277.49
| Facility | | $277.49 | $277.49 | $277.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.67 / $350.34 / $1,459.79
| Professional | | $236.67 | $350.34 | $1,459.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,022.60 / $7,613.01 / $22,059.93
| Facility | | $4,022.60 | $7,613.01 | $22,059.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.22 / $290.69 / $441.97
| Professional | | $200.22 | $290.69 | $441.97 |