- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $5,011.87 / $7,762.47
| Facility | | $1,380.38 | $5,011.87 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $177.83 / $363.08
| Professional | | $128.82 | $177.83 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $25,118.86 / $40,738.03
| Facility | | $11,481.54 | $25,118.86 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $60.26 / $85.11
| Professional | | $60.26 | $60.26 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $371.54 / $741.31
| Facility | | $120.23 | $371.54 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $11,220.18 / $38,018.94
| Facility | | $891.25 | $11,220.18 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $275.42 / $389.05
| Professional | | $213.80 | $275.42 | $389.05 |