- 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
- $229.09 / $316.23 / $602.56
| Professional | | $229.09 | $316.23 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,090.30 / $4,168.69
| Facility | | $2,630.27 | $3,090.30 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $363.08 / $426.58
| Professional | | $257.04 | $363.08 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $354.81 / $912.01
| Professional | | $245.47 | $354.81 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,778.28 / $5,370.32
| Facility | | $660.69 | $1,778.28 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $295.12 / $446.68
| Professional | | $213.80 | $295.12 | $446.68 |