- 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
- $275.42 / $346.74 / $407.38
| Professional | | $275.42 | $346.74 | $407.38 |
- 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
- $354.81 / $354.81 / $794.33
| Facility | | $354.81 | $354.81 | $794.33 |
- 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
- $407.38 / $537.03 / $724.44
| Professional | | $407.38 | $537.03 | $724.44 |