- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $5,248.07 / $12,302.69
| Facility | | $1,071.52 | $5,248.07 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $616.60 / $1,445.44
| Professional | | $524.81 | $616.60 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $9,549.93 / $17,782.79
| Facility | | $3,235.94 | $9,549.93 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $660.69 / $1,230.27
| Professional | | $512.86 | $660.69 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,995.26 / $5,011.87
| Facility | | $831.76 | $1,995.26 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $758.58 / $1,621.81
| Professional | | $501.19 | $758.58 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $6,606.93 / $15,848.93
| Facility | | $1,778.28 | $6,606.93 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $660.69 / $1,202.26
| Professional | | $467.74 | $660.69 | $1,202.26 |