- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,081.18 / $1,250.66 / $1,988.70
| Facility | | $1,081.18 | $1,250.66 | $1,988.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.63 / $248.73 / $378.16
| Professional | | $149.63 | $248.73 | $378.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.03 / $598.94 / $688.51
| Professional | | $332.03 | $598.94 | $688.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.97 / $306.39 / $2,047.43
| Professional | | $226.97 | $306.39 | $2,047.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.97 / $357.46 / $1,190.09
| Facility | | $222.97 | $357.46 | $1,190.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.38 / $564.99 / $1,557.41
| Professional | | $273.38 | $564.99 | $1,557.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.03 / $611.71 / $638.25
| Facility | | $332.03 | $611.71 | $638.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.03 / $611.71 / $778.67
| Professional | | $332.03 | $611.71 | $778.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.70 / $569.29 / $616.52
| Professional | | $248.70 | $569.29 | $616.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.57 / $486.02 / $817.11
| Professional | | $288.57 | $486.02 | $817.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $419.17 / $530.60 / $530.60
| Professional | | $419.17 | $530.60 | $530.60 |