- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $6,025.60 / $13,803.84
| Facility | | $1,548.82 | $6,025.60 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $549.54 / $707.95
| Professional | | $363.08 | $549.54 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $9,332.54 / $28,840.32
| Facility | | $4,570.88 | $9,332.54 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $588.84 / $1,071.52
| Professional | | $457.09 | $588.84 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $14,125.38 / $33,884.42
| Facility | | $691.83 | $14,125.38 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $2,041.74 / $2,041.74
| Professional | | $676.08 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $12,022.64 / $28,840.32
| Facility | | $3,630.78 | $12,022.64 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $812.83 / $1,380.38
| Professional | | $537.03 | $812.83 | $1,380.38 |