- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,890.45 / $7,762.47
| Facility | | $1,288.25 | $3,890.45 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $263.03 / $457.09
| Professional | | $223.87 | $263.03 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $7,943.28 / $13,182.57
| Facility | | $5,128.61 | $7,943.28 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $323.59 / $389.05
| Professional | | $245.47 | $323.59 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,862.09 / $7,244.36
| Facility | | $269.15 | $1,862.09 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $288.40 / $1,778.28
| Professional | | $213.80 | $288.40 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,311.31 / $6,025.60
| Facility | | $891.25 | $3,311.31 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $263.03 / $371.54
| Professional | | $199.53 | $263.03 | $371.54 |