- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,388.44 / $7,762.47
| Facility | | $1,047.13 | $3,388.44 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $912.01 / $1,380.38
| Professional | | $776.25 | $912.01 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $7,585.78 / $10,715.19
| Facility | | $4,466.84 | $7,585.78 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,122.02 / $1,318.26
| Professional | | $954.99 | $1,122.02 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $39.81
| Facility | | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,047.13 / $1,348.96
| Professional | | $602.56 | $1,047.13 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,630.27 / $5,888.44
| Facility | | $831.76 | $2,630.27 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $912.01 / $1,479.11
| Professional | | $691.83 | $912.01 | $1,479.11 |