- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $5,370.32 / $12,882.50
| Facility | | $1,071.52 | $5,370.32 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $724.44 / $2,137.96
| Professional | | $602.56 | $724.44 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $9,549.93 / $17,782.79
| Facility | | $3,548.13 | $9,549.93 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $870.96 / $1,659.59
| Professional | | $602.56 | $870.96 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,819.70 / $5,495.41
| Facility | | $323.59 | $1,819.70 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,000.00 / $2,137.96
| Professional | | $660.69 | $1,000.00 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,754.40 / $14,125.38
| Facility | | $1,905.46 | $5,754.40 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $794.33 / $1,479.11
| Professional | | $562.34 | $794.33 | $1,479.11 |