- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,344.23 / $3,467.37
| Facility | | $1,071.52 | $2,344.23 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $354.81 / $562.34
| Professional | | $208.93 | $354.81 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,442.29 / $23,442.29 / $32,359.37
| Facility | | $23,442.29 | $23,442.29 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $14,125.38 / $36,307.81
| Facility | | $3,715.35 | $14,125.38 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $436.52 / $724.44
| Professional | | $316.23 | $436.52 | $724.44 |