- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $4,786.30 / $11,481.54
| Facility | | $1,071.52 | $4,786.30 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $645.65 / $1,412.54
| Professional | | $524.81 | $645.65 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $8,317.64 / $15,488.17
| Facility | | $3,162.28 | $8,317.64 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $741.31 / $1,445.44
| Professional | | $489.78 | $741.31 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,949.84 / $4,897.79
| Facility | | $977.24 | $1,949.84 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $870.96 / $1,862.09
| Professional | | $537.03 | $870.96 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,365.16 / $10,232.93
| Facility | | $1,584.89 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $707.95 / $1,318.26
| Professional | | $489.78 | $707.95 | $1,318.26 |