- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,445.44 / $2,398.83
| Facility | | $1,096.48 | $1,445.44 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $218.78 / $302.00
| Professional | | $186.21 | $218.78 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $6,760.83 / $9,332.54
| Facility | | $5,754.40 | $6,760.83 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $549.54
| Facility | | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,412.54 / $1,412.54
| Professional | | $1,412.54 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $4,168.69 / $6,309.57
| Facility | | $1,202.26 | $4,168.69 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $251.19 / $630.96
| Professional | | $33.88 | $251.19 | $630.96 |