- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $8,912.51 / $14,791.08
| Facility | | $3,311.31 | $8,912.51 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $275.42 / $446.68
| Professional | | $218.78 | $275.42 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $60.26 / $85.11
| Professional | | $60.26 | $60.26 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $478.63 / $1,023.29
| Facility | | $309.03 | $478.63 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $11,220.18 / $16,982.44
| Facility | | $891.25 | $11,220.18 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $416.87 / $562.34
| Professional | | $316.23 | $416.87 | $562.34 |