- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,168.68 / $1,168.68 / $1,665.90
| Facility | | $1,168.68 | $1,168.68 | $1,665.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.51 / $1,249.42 / $1,249.42
| Professional | | $448.51 | $1,249.42 | $1,249.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,498.82 / $2,498.82 / $2,498.82
| Facility | | $2,498.82 | $2,498.82 | $2,498.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $608.46 / $736.38 / $920.47
| Professional | | $608.46 | $736.38 | $920.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $608.69 / $1,249.42 / $1,324.39
| Facility | | $608.69 | $1,249.42 | $1,324.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $640.73 / $640.73 / $768.88
| Professional | | $640.73 | $640.73 | $768.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $961.10 / $1,281.46 / $2,306.63
| Facility | | $961.10 | $1,281.46 | $2,306.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $544.62 / $1,100.56 / $1,127.08
| Professional | | $544.62 | $1,100.56 | $1,127.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.11 / $269.11 / $768.88
| Professional | | $269.11 | $269.11 | $768.88 |