- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $6,025.60 / $14,454.40
| Facility | | $1,122.02 | $6,025.60 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $489.78 / $1,230.27
| Professional | | $389.05 | $489.78 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $8,511.38 / $17,378.01
| Facility | | $3,630.78 | $8,511.38 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $562.34 / $1,096.48
| Professional | | $371.54 | $562.34 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,548.82 / $10,715.19
| Facility | | $676.08 | $1,548.82 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $660.69 / $1,445.44
| Professional | | $416.87 | $660.69 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,709.64 / $18,620.87
| Facility | | $3,019.95 | $8,709.64 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $524.81 / $977.24
| Professional | | $371.54 | $524.81 | $977.24 |