- 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
- $144.54 / $281.84 / $602.56
| Professional | | $144.54 | $281.84 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,398.83 / $3,235.94
| Facility | | $2,041.74 | $2,398.83 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $257.04 / $398.11
| Professional | | $177.83 | $257.04 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $257.04 / $630.96
| Professional | | $141.25 | $257.04 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $1,148.15 / $2,511.89
| Facility | | $407.38 | $1,148.15 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $223.87 / $389.05
| Professional | | $138.04 | $223.87 | $389.05 |