- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $9,120.11 / $16,595.87
| Facility | | $6,760.83 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $363.08
| Professional | | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,897.79 / $9,120.11
| Facility | | $2,754.23 | $4,897.79 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $257.04 / $263.03
| Professional | | $251.19 | $257.04 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $575.44
| Facility | | $371.54 | $371.54 | $575.44 |
- 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
- $5,128.61 / $13,182.57 / $23,442.29
| Facility | | $5,128.61 | $13,182.57 | $23,442.29 |