- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,071.52 / $2,454.71
| Facility | | $537.03 | $1,071.52 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $467.74 / $724.44
| Professional | | $331.13 | $467.74 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $1,995.26
| Facility | | $1,445.44 | $1,445.44 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $524.81 / $724.44
| Professional | | $398.11 | $524.81 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,187.76
| Facility | | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $616.60 / $851.14
| Professional | | $389.05 | $616.60 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,041.74 / $4,570.88
| Facility | | $977.24 | $2,041.74 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $537.03 / $870.96
| Professional | | $363.08 | $537.03 | $870.96 |