- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $5,011.87 / $10,471.29
| Facility | | $2,691.53 | $5,011.87 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $501.19 / $933.25
| Professional | | $416.87 | $501.19 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $12,302.69 / $13,803.84
| Facility | | $7,413.10 | $12,302.69 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $891.25 / $1,202.26
| Professional | | $416.87 | $891.25 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,090.30 / $5,011.87
| Facility | | $1,023.29 | $3,090.30 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $676.08 / $1,445.44
| Professional | | $398.11 | $676.08 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $724.44 / $933.25
| Professional | | $549.54 | $724.44 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $7,762.47 / $11,481.54
| Facility | | $1,047.13 | $7,762.47 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $588.84 / $1,380.38
| Professional | | $407.38 | $588.84 | $1,380.38 |