- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,630.78 / $7,762.47
| Facility | | $1,412.54 | $3,630.78 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $173.78 / $478.63
| Professional | | $120.23 | $173.78 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $1,023.29 / $1,513.56
| Facility | | $316.23 | $1,023.29 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $147.91 / $223.87
| Professional | | $112.20 | $147.91 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $173.78 / $309.03
| Professional | | $128.82 | $173.78 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $194.98 / $1,905.46
| Facility | | $128.82 | $194.98 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $199.53 / $1,380.38
| Professional | | $158.49 | $199.53 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,412.54 / $2,187.76
| Facility | | $691.83 | $1,412.54 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $162.18 / $239.88
| Professional | | $123.03 | $162.18 | $239.88 |