- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $4,570.88 / $10,964.78
| Facility | | $1,202.26 | $4,570.88 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $758.58 / $870.96
| Professional | | $524.81 | $758.58 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,760.83 / $14,454.40
| Facility | | $3,311.31 | $6,760.83 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $812.83 / $1,621.81
| Professional | | $660.69 | $812.83 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $3,090.30 / $7,413.10
| Facility | | $1,318.26 | $3,090.30 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,174.90 / $1,348.96
| Professional | | $933.25 | $1,174.90 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $7,079.46 / $15,848.93
| Facility | | $2,238.72 | $7,079.46 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $870.96 / $1,584.89
| Professional | | $645.65 | $870.96 | $1,584.89 |