- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $4,677.35 / $10,964.78
| Facility | | $1,174.90 | $4,677.35 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $537.03 / $660.69
| Professional | | $316.23 | $537.03 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $7,585.78 / $15,488.17
| Facility | | $3,388.44 | $7,585.78 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $257.04 / $776.25
| Professional | | $95.50 | $257.04 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $4,677.35
| Facility | | $562.34 | $562.34 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $1,584.89 / $1,584.89
| Professional | | $380.19 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,623.41 / $12,589.25
| Facility | | $1,905.46 | $5,623.41 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $758.58 / $1,288.25
| Professional | | $478.63 | $758.58 | $1,288.25 |