- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,235.94 / $5,128.61
| Facility | | $1,819.70 | $3,235.94 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $389.05 / $1,380.38
| Professional | | $338.84 | $389.05 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $1,148.15
| Facility | | $1,148.15 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $1,862.09
| Facility | | $416.87 | $416.87 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $1,348.96
| Professional | | $416.87 | $416.87 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,621.81 / $1,659.59
| Facility | | $1,548.82 | $1,621.81 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $933.25 / $933.25
| Professional | | $933.25 | $933.25 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $1,148.15 / $1,995.26
| Facility | | $331.13 | $1,148.15 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $831.76 / $1,258.93
| Professional | | $251.19 | $831.76 | $1,258.93 |