- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,445.44 / $2,398.83
| Facility | | $1,096.48 | $1,445.44 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,071.52 / $1,445.44
| Professional | | $794.33 | $1,071.52 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $489.78 / $676.08
| Facility | | $416.87 | $489.78 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $93.33 / $109.65
| Professional | | $64.57 | $93.33 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $870.96 / $1,412.54
| Professional | | $354.81 | $870.96 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $562.34 / $1,548.82
| Facility | | $251.19 | $562.34 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $371.54 / $489.78
| Professional | | $245.47 | $371.54 | $489.78 |