- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $7,762.47 / $8,709.64
| Facility | | $1,548.82 | $7,762.47 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $489.78 / $588.84
| Professional | | $398.11 | $489.78 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $60.26 / $85.11
| Professional | | $60.26 | $60.26 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $1,122.02
| Facility | | $501.19 | $501.19 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $9,120.11 / $16,218.10
| Facility | | $794.33 | $9,120.11 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $812.83 / $1,096.48
| Professional | | $602.56 | $812.83 | $1,096.48 |