- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $4,570.88 / $9,772.37
| Facility | | $1,380.38 | $4,570.88 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $575.44 / $741.31
| Professional | | $489.78 | $575.44 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $15,848.93
| Facility | | $5,495.41 | $5,495.41 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $7,244.36 / $21,379.62
| Facility | | $489.78 | $7,244.36 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $707.95 / $4,265.80
| Professional | | $537.03 | $707.95 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $10,715.19 / $21,379.62
| Facility | | $3,467.37 | $10,715.19 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $707.95 / $1,023.29
| Professional | | $512.86 | $707.95 | $1,023.29 |