- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,890.45 / $6,760.83
| Facility | | $1,737.80 | $3,890.45 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $457.09 / $1,584.89
| Professional | | $281.84 | $457.09 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,778.28 / $2,691.53
| Facility | | $549.54 | $1,778.28 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $363.08 / $562.34
| Professional | | $275.42 | $363.08 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $457.09 / $776.25
| Professional | | $295.12 | $457.09 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $501.19 / $3,890.45
| Facility | | $309.03 | $501.19 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $549.54 / $3,890.45
| Professional | | $407.38 | $549.54 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,311.31 / $5,370.32
| Facility | | $2,290.87 | $3,311.31 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $407.38 / $645.65
| Professional | | $275.42 | $407.38 | $645.65 |