- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,905.46 / $5,248.07
| Facility | | $1,071.52 | $1,905.46 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $616.60 / $851.14
| Professional | | $501.19 | $616.60 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,479.11 / $4,365.16
| Facility | | $1,288.25 | $1,479.11 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $489.78 / $489.78
| Professional | | $489.78 | $489.78 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,754.23 / $3,311.31
| Facility | | $1,096.48 | $2,754.23 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $794.33 / $3,162.28
| Professional | | $389.05 | $794.33 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $1,445.44
| Professional | | $758.58 | $758.58 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $457.09 / $1,445.44
| Professional | | $457.09 | $457.09 | $1,445.44 |