- 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
- $173.78 / $251.19 / $316.23
| Professional | | $173.78 | $251.19 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $6,606.93 / $13,803.84
| Facility | | $2,630.27 | $6,606.93 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $263.03 / $549.54
| Professional | | $204.17 | $263.03 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $851.14
| Facility | | $416.87 | $416.87 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $1,230.27 / $1,230.27
| Professional | | $467.74 | $1,230.27 | $1,230.27 |
- 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
- $234.42 / $316.23 / $562.34
| Professional | | $234.42 | $316.23 | $562.34 |