- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $3,235.94 / $7,244.36
| Facility | | $1,318.26 | $3,235.94 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $331.13 / $831.76
| Professional | | $295.12 | $331.13 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,023.29 / $1,023.29
| Facility | | $1,023.29 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $331.13 / $588.84
| Professional | | $257.04 | $331.13 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $436.52 / $562.34
| Professional | | $416.87 | $436.52 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,479.11
| Facility | | $1,000.00 | $1,000.00 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $354.81 / $537.03
| Professional | | $275.42 | $354.81 | $537.03 |