- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $5,248.07 / $9,120.11
| Facility | | $1,778.28 | $5,248.07 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $338.84 / $933.25
| Professional | | $138.04 | $338.84 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $1,548.82
| Professional | | $151.36 | $151.36 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $389.05 / $1,047.13
| Professional | | $144.54 | $389.05 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $426.58 / $676.08
| Professional | | $239.88 | $426.58 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $6,918.31 / $10,471.29
| Facility | | $4,265.80 | $6,918.31 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $380.19 / $851.14
| Professional | | $114.82 | $380.19 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $6,606.93 / $10,964.78
| Facility | | $2,951.21 | $6,606.93 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $281.84 / $707.95
| Professional | | $107.15 | $281.84 | $707.95 |