- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $4,570.88 / $10,964.78
| Facility | | $1,071.52 | $4,570.88 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $1,479.11
| Professional | | $363.08 | $363.08 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,248.07 / $10,964.78
| Facility | | $1,995.26 | $5,248.07 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $229.09 / $660.69
| Professional | | $169.82 | $229.09 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,174.90 / $2,754.23
| Facility | | $831.76 | $1,174.90 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $812.83 / $1,348.96
| Professional | | $489.78 | $812.83 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,951.21 / $6,456.54
| Facility | | $1,023.29 | $2,951.21 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $741.31 / $1,445.44
| Professional | | $371.54 | $741.31 | $1,445.44 |