- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,325.68 / $1,657.10 / $2,896.71
| Facility | | $1,325.68 | $1,657.10 | $2,896.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.29 / $535.26 / $739.92
| Professional | | $472.29 | $535.26 | $739.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,007.55 / $2,266.98 / $3,798.31
| Facility | | $1,007.55 | $2,266.98 | $3,798.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.60 / $330.60 / $787.15
| Professional | | $330.60 | $330.60 | $787.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.25 / $527.00 / $2,404.76
| Facility | | $450.25 | $527.00 | $2,404.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $964.06 / $964.06 / $1,141.36
| Professional | | $964.06 | $964.06 | $1,141.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $598.23 / $787.15 / $1,102.01
| Facility | | $598.23 | $787.15 | $1,102.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $629.72 / $1,102.01 / $1,574.30
| Professional | | $629.72 | $1,102.01 | $1,574.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $708.44 / $708.44 / $708.44
| Facility | | $708.44 | $708.44 | $708.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.60 / $330.60 / $472.29
| Professional | | $330.60 | $330.60 | $472.29 |