- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,548.82 / $4,265.80
| Facility | | $1,548.82 | $1,548.82 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $446.68 / $524.81
| Professional | | $331.13 | $446.68 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,174.90 / $3,467.37
| Facility | | $1,047.13 | $1,174.90 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $398.11 / $575.44
| Professional | | $112.20 | $398.11 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,905.46 / $2,691.53
| Facility | | $977.24 | $1,905.46 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $1,148.15
| Professional | | $602.56 | $602.56 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $602.56
| Professional | | $363.08 | $363.08 | $602.56 |