- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $4,677.35 / $10,964.78
| Facility | | $1,202.26 | $4,677.35 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $954.99 / $1,230.27
| Professional | | $660.69 | $954.99 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $7,943.28 / $15,135.61
| Facility | | $2,754.23 | $7,943.28 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $977.24 / $1,995.26
| Professional | | $524.81 | $977.24 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,348.96 / $4,570.88
| Facility | | $741.31 | $1,348.96 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,288.25 / $1,479.11
| Professional | | $1,174.90 | $1,288.25 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $4,265.80 / $10,715.19
| Facility | | $1,412.54 | $4,265.80 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,174.90 / $2,137.96
| Professional | | $831.76 | $1,174.90 | $2,137.96 |