- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $5,128.61 / $12,022.64
| Facility | | $1,071.52 | $5,128.61 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $660.69 / $1,445.44
| Professional | | $549.54 | $660.69 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $9,772.37 / $17,782.79
| Facility | | $3,388.44 | $9,772.37 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $812.83 / $1,513.56
| Professional | | $537.03 | $812.83 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,513.56 / $5,011.87
| Facility | | $398.11 | $1,513.56 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $912.01 / $1,949.84
| Professional | | $575.44 | $912.01 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,079.46 / $15,848.93
| Facility | | $2,454.71 | $7,079.46 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $741.31 / $1,348.96
| Professional | | $512.86 | $741.31 | $1,348.96 |