- 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
- $158.49 / $234.42 / $281.84
| Professional | | $158.49 | $234.42 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $6,456.54 / $13,803.84
| Facility | | $3,388.44 | $6,456.54 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $281.84 / $524.81
| Professional | | $213.80 | $281.84 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $891.25 / $12,589.25
| Facility | | $416.87 | $891.25 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $316.23 / $389.05
| Professional | | $269.15 | $316.23 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,623.41 / $12,589.25
| Facility | | $1,862.09 | $5,623.41 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $316.23 / $575.44
| Professional | | $218.78 | $316.23 | $575.44 |