- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,290.87 / $6,309.57
| Facility | | $1,258.93 | $2,290.87 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $602.56 / $812.83
| Professional | | $346.74 | $602.56 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,737.80 / $5,128.61
| Facility | | $1,548.82 | $1,737.80 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $588.84 / $660.69
| Professional | | $354.81 | $588.84 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $3,311.31 / $3,890.45
| Facility | | $691.83 | $3,311.31 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $1,023.29 / $3,715.35
| Professional | | $467.74 | $1,023.29 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $1,698.24
| Professional | | $891.25 | $891.25 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $537.03 / $1,380.38
| Professional | | $537.03 | $537.03 | $1,380.38 |