- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $3,890.45 / $8,511.38
| Facility | | $1,202.26 | $3,890.45 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $467.74 / $851.14
| Professional | | $398.11 | $467.74 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $891.25
| Facility | | $891.25 | $891.25 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $602.56 / $741.31
| Professional | | $478.63 | $602.56 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $1,445.44 / $7,585.78
| Facility | | $478.63 | $1,445.44 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $512.86 / $3,311.31
| Professional | | $371.54 | $512.86 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $5,495.41 / $10,471.29
| Facility | | $1,479.11 | $5,495.41 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $467.74 / $645.65
| Professional | | $363.08 | $467.74 | $645.65 |