- 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
- $218.78 / $316.23 / $398.11
| Professional | | $218.78 | $316.23 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,570.88 / $10,471.29
| Facility | | $2,238.72 | $4,570.88 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $309.03 / $602.56
| Professional | | $213.80 | $309.03 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $562.34 / $851.14
| Facility | | $524.81 | $562.34 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $1,584.89 / $1,584.89
| Professional | | $426.58 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $3,090.30 / $10,232.93
| Facility | | $741.31 | $3,090.30 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $389.05 / $707.95
| Professional | | $288.40 | $389.05 | $707.95 |