- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $3,981.07 / $8,709.64
| Facility | | $1,202.26 | $3,981.07 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $257.04 / $446.68
| Professional | | $223.87 | $257.04 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $6,456.54 / $10,964.78
| Facility | | $3,467.37 | $6,456.54 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $338.84 / $478.63
| Professional | | $257.04 | $338.84 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $1,412.54
| Facility | | $602.56 | $602.56 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $331.13 / $489.78
| Professional | | $251.19 | $331.13 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $776.25
| Professional | | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $1,445.44 / $1,479.11
| Professional | | $309.03 | $1,445.44 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $5,623.41 / $11,481.54
| Facility | | $2,454.71 | $5,623.41 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $338.84 / $512.86
| Professional | | $239.88 | $338.84 | $512.86 |