- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $5,495.41 / $10,964.78
| Facility | | $1,047.13 | $5,495.41 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $537.03 / $1,122.02
| Professional | | $426.58 | $537.03 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $398.11 / $794.33
| Facility | | $34.67 | $398.11 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $660.69 / $1,071.52
| Professional | | $416.87 | $660.69 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $20,892.96 / $33,113.11
| Facility | | $9,120.11 | $20,892.96 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $346.74 / $562.34
| Professional | | $323.59 | $346.74 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $602.56
| Professional | | $32.36 | $33.11 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $5,128.61 / $10,715.19
| Facility | | $676.08 | $5,128.61 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $645.65 / $1,096.48
| Professional | | $436.52 | $645.65 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $354.81 / $354.81
| Professional | | $354.81 | $354.81 | $354.81 |