- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $5,128.61 / $11,748.98
| Facility | | $1,445.44 | $5,128.61 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $331.13 / $398.11
| Professional | | $223.87 | $331.13 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $12,022.64 / $27,542.29
| Facility | | $5,495.41 | $12,022.64 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $467.74 / $954.99
| Professional | | $371.54 | $467.74 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,202.26 / $12,589.25
| Facility | | $616.60 | $1,202.26 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $457.09 / $549.54
| Professional | | $371.54 | $457.09 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $11,220.18 / $26,302.68
| Facility | | $3,630.78 | $11,220.18 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $446.68 / $812.83
| Professional | | $309.03 | $446.68 | $812.83 |