- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,445.44 / $2,398.83
| Facility | | $1,096.48 | $1,445.44 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $123.03 / $229.09
| Professional | | $104.71 | $123.03 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $8,511.38 / $11,481.54
| Facility | | $7,244.36 | $8,511.38 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $177.83 / $218.78
| Professional | | $131.83 | $177.83 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $165.96 / $275.42
| Professional | | $109.65 | $165.96 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,659.59 / $5,248.07
| Facility | | $660.69 | $1,659.59 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $131.83 / $257.04
| Professional | | $89.13 | $131.83 | $257.04 |