- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $10,471.29 / $18,197.01
| Facility | | $7,943.28 | $10,471.29 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $251.19 / $288.40
| Professional | | $208.93 | $251.19 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $251.19 / $316.23
| Facility | | $199.53 | $251.19 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Professional | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $6,760.83 / $9,120.11
| Facility | | $1,479.11 | $6,760.83 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $281.84 / $467.74
| Professional | | $229.09 | $281.84 | $467.74 |