- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $5,128.61 / $12,302.69
| Facility | | $1,096.48 | $5,128.61 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $676.08 / $1,584.89
| Professional | | $575.44 | $676.08 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $9,772.37 / $17,782.79
| Facility | | $3,388.44 | $9,772.37 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $851.14 / $1,548.82
| Professional | | $588.84 | $851.14 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,698.24 / $5,495.41
| Facility | | $323.59 | $1,698.24 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $954.99 / $1,995.26
| Professional | | $630.96 | $954.99 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $7,079.46 / $16,218.10
| Facility | | $2,344.23 | $7,079.46 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $758.58 / $1,412.54
| Professional | | $537.03 | $758.58 | $1,412.54 |