- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $10,471.29 / $18,197.01
| Facility | | $1,621.81 | $10,471.29 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $630.96 / $1,445.44
| Professional | | $562.34 | $630.96 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $5,623.41 / $10,471.29
| Facility | | $2,344.23 | $5,623.41 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $758.58 / $1,174.90
| Professional | | $524.81 | $758.58 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,089.30 / $2,691.53
| Facility | | $2,089.30 | $2,089.30 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $794.33 / $1,380.38
| Professional | | $616.60 | $794.33 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $870.96 / $1,380.38
| Facility | | $602.56 | $870.96 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $11,220.18 / $16,982.44
| Facility | | $2,754.23 | $11,220.18 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $707.95 / $1,230.27
| Professional | | $562.34 | $707.95 | $1,230.27 |