- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $5,128.61 / $11,748.98
| Facility | | $1,445.44 | $5,128.61 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $776.25 / $954.99
| Professional | | $346.74 | $776.25 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $9,332.54 / $26,915.35
| Facility | | $4,570.88 | $9,332.54 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $549.54 / $1,202.26
| Professional | | $389.05 | $549.54 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $6,918.31 / $33,884.42
| Facility | | $588.84 | $6,918.31 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,737.80 / $1,737.80
| Professional | | $588.84 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $10,964.78 / $25,703.96
| Facility | | $3,630.78 | $10,964.78 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,071.52 / $1,862.09
| Professional | | $660.69 | $1,071.52 | $1,862.09 |