- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,890.45 / $9,772.37
| Facility | | $1,071.52 | $3,890.45 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $363.08 / $436.52
| Professional | | $245.47 | $363.08 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,677.35 / $10,964.78
| Facility | | $1,819.70 | $4,677.35 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $239.88 / $467.74
| Professional | | $87.10 | $239.88 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $707.95 / $1,737.80
| Facility | | $562.34 | $707.95 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,819.70 / $1,819.70
| Professional | | $616.60 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $2,630.27 / $6,309.57
| Facility | | $660.69 | $2,630.27 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $457.09 / $812.83
| Professional | | $323.59 | $457.09 | $812.83 |