- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $5,370.32 / $14,454.40
| Facility | | $1,479.11 | $5,370.32 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $323.59 / $416.87
| Professional | | $223.87 | $323.59 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $4,677.35 / $11,748.98
| Facility | | $1,905.46 | $4,677.35 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $331.13 / $691.83
| Professional | | $229.09 | $331.13 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $537.03 / $18,197.01
| Facility | | $331.13 | $537.03 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $1,513.56 / $1,513.56
| Professional | | $436.52 | $1,513.56 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,905.46 / $4,786.30
| Facility | | $537.03 | $1,905.46 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $457.09 / $812.83
| Professional | | $309.03 | $457.09 | $812.83 |