- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $5,888.44 / $12,882.50
| Facility | | $1,737.80 | $5,888.44 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $316.23 / $501.19
| Professional | | $269.15 | $316.23 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,467.37 / $8,511.38
| Facility | | $2,454.71 | $3,467.37 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $457.09 / $645.65
| Professional | | $354.81 | $457.09 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $512.86
| Professional | | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $275.42 / $331.13
| Professional | | $275.42 | $275.42 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,290.87 / $3,890.45
| Facility | | $1,258.93 | $2,290.87 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $537.03 / $870.96
| Professional | | $416.87 | $537.03 | $870.96 |