- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,890.45 / $7,762.47
| Facility | | $1,288.25 | $3,890.45 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $229.09 / $288.40
| Professional | | $194.98 | $229.09 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,090.30 / $5,011.87
| Facility | | $1,995.26 | $3,090.30 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $3,981.07 / $9,549.93
| Facility | | $194.98 | $3,981.07 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $257.04 / $416.87
| Professional | | $208.93 | $257.04 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,495.41 / $10,471.29
| Facility | | $1,621.81 | $5,495.41 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $251.19 / $338.84
| Professional | | $199.53 | $251.19 | $338.84 |