- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,897.79 / $10,471.29
| Facility | | $1,698.24 | $4,897.79 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $186.21 / $275.42
| Professional | | $134.90 | $186.21 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $12,302.69 / $13,803.84
| Facility | | $7,413.10 | $12,302.69 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $309.03 / $549.54
| Professional | | $239.88 | $309.03 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $1,659.59 / $2,187.76
| Facility | | $354.81 | $1,659.59 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $316.23 / $602.56
| Professional | | $269.15 | $316.23 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $8,511.38 / $11,748.98
| Facility | | $5,370.32 | $8,511.38 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $380.19 / $741.31
| Professional | | $245.47 | $380.19 | $741.31 |