- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $4,897.79 / $11,481.54
| Facility | | $1,071.52 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $660.69 / $1,348.96
| Professional | | $549.54 | $660.69 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $8,317.64 / $16,218.10
| Facility | | $2,951.21 | $8,317.64 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $724.44 / $1,318.26
| Professional | | $524.81 | $724.44 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,819.70 / $4,466.84
| Facility | | $758.58 | $1,819.70 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $812.83 / $1,737.80
| Professional | | $524.81 | $812.83 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,011.87 / $12,022.64
| Facility | | $1,348.96 | $5,011.87 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $691.83 / $1,258.93
| Professional | | $501.19 | $691.83 | $1,258.93 |