- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,365.16 / $7,413.10
| Facility | | $2,290.87 | $4,365.16 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $575.44 / $707.95
| Professional | | $223.87 | $575.44 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $6,309.57 / $12,302.69
| Facility | | $2,137.96 | $6,309.57 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $602.56 / $645.65
| Professional | | $478.63 | $602.56 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $2,511.89
| Facility | | $1,202.26 | $1,202.26 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,258.93 / $3,548.13
| Professional | | $1,202.26 | $1,258.93 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,071.52 / $4,786.30
| Professional | | $758.58 | $1,071.52 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $3,311.31 / $9,120.11
| Facility | | $575.44 | $3,311.31 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $870.96 / $1,584.89
| Professional | | $537.03 | $870.96 | $1,584.89 |