- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,629.24 / $2,217.92 / $8,084.40
| Facility | | $1,629.24 | $2,217.92 | $8,084.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $922.21 / $1,859.79 / $1,998.13
| Professional | | $922.21 | $1,859.79 | $1,998.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,664.29 / $3,001.65 / $4,729.72
| Facility | | $1,664.29 | $3,001.65 | $4,729.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $547.09 / $597.91 / $663.68
| Professional | | $547.09 | $597.91 | $663.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,537.02 / $1,537.02 / $1,537.02
| Facility | | $1,537.02 | $1,537.02 | $1,537.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $999.06 / $1,237.83 / $11,670.29
| Facility | | $999.06 | $1,237.83 | $11,670.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.54 / $827.58 / $2,151.83
| Professional | | $645.54 | $827.58 | $2,151.83 |