- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $10,964.78 / $16,595.87
| Facility | | $3,890.45 | $10,964.78 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $234.42 / $295.12
| Professional | | $223.87 | $234.42 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $295.12 / $416.87
| Facility | | $147.91 | $295.12 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $245.47 / $295.12
| Professional | | $144.54 | $245.47 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,047.13 / $1,348.96
| Professional | | $1,000.00 | $1,047.13 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $295.12 / $426.58
| Facility | | $162.18 | $295.12 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $602.56 / $1,380.38
| Professional | | $354.81 | $602.56 | $1,380.38 |