- 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 / $229.09 / $295.12
| Professional | | $158.49 | $229.09 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,943.28 / $15,135.61
| Facility | | $2,818.38 | $7,943.28 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $295.12 / $588.84
| Professional | | $213.80 | $295.12 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $407.38 / $851.14
| Facility | | $407.38 | $407.38 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $1,148.15 / $1,148.15
| Professional | | $309.03 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $6,606.93 / $15,488.17
| Facility | | $1,778.28 | $6,606.93 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $288.40 / $512.86
| Professional | | $208.93 | $288.40 | $512.86 |