- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $5,623.41 / $13,489.63
| Facility | | $1,202.26 | $5,623.41 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $707.95 / $1,380.38
| Professional | | $588.84 | $707.95 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $10,232.93 / $19,952.62
| Facility | | $3,630.78 | $10,232.93 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $776.25 / $1,412.54
| Professional | | $537.03 | $776.25 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,122.02 / $12,022.64
| Facility | | $489.78 | $1,122.02 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $891.25 / $1,819.70
| Professional | | $575.44 | $891.25 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $7,762.47 / $17,782.79
| Facility | | $2,137.96 | $7,762.47 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $758.58 / $1,348.96
| Professional | | $549.54 | $758.58 | $1,348.96 |