- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $6,918.31 / $16,595.87
| Facility | | $1,047.13 | $6,918.31 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $338.84 / $691.83
| Professional | | $263.03 | $338.84 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $6,165.95 / $12,302.69
| Facility | | $2,630.27 | $6,165.95 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $380.19 / $741.31
| Professional | | $234.42 | $380.19 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $794.33 / $2,290.87
| Facility | | $281.84 | $794.33 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $457.09 / $933.25
| Professional | | $295.12 | $457.09 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $380.19 / $691.83
| Professional | | $263.03 | $380.19 | $691.83 |