- 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
- $741.31 / $954.99 / $1,548.82
| Professional | | $741.31 | $954.99 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,570.40 / $3,467.37
| Facility | | $2,137.96 | $2,570.40 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,348.96 / $1,905.46
| Professional | | $1,071.52 | $1,348.96 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $954.99 / $1,621.81
| Professional | | $575.44 | $954.99 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,884.03 / $4,168.69
| Facility | | $812.83 | $2,884.03 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $812.83 / $1,258.93
| Professional | | $588.84 | $812.83 | $1,258.93 |