- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $5,128.61 / $12,882.50
| Facility | | $1,230.27 | $5,128.61 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $588.84 / $870.96
| Professional | | $407.38 | $588.84 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $6,760.83 / $16,218.10
| Facility | | $3,090.30 | $6,760.83 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $630.96 / $1,445.44
| Professional | | $199.53 | $630.96 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $891.25 / $10,471.29
| Facility | | $398.11 | $891.25 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $851.14 / $3,630.78
| Professional | | $501.19 | $851.14 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $6,918.31 / $16,982.44
| Facility | | $1,737.80 | $6,918.31 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $691.83 / $1,737.80
| Professional | | $389.05 | $691.83 | $1,737.80 |