- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,659.59 / $2,344.23
| Facility | | $1,096.48 | $1,659.59 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $295.12 / $549.54
| Professional | | $245.47 | $295.12 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $5,623.41 / $7,585.78
| Facility | | $4,677.35 | $5,623.41 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $371.54 / $467.74
| Professional | | $269.15 | $371.54 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $467.74
| Facility | | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $331.13 / $707.95
| Professional | | $234.42 | $331.13 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $549.54 / $1,348.96
| Facility | | $251.19 | $549.54 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $288.40 / $512.86
| Professional | | $213.80 | $288.40 | $512.86 |