- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,128.61 / $8,511.38
| Facility | | $3,467.37 | $5,128.61 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $446.68 / $1,047.13
| Professional | | $144.54 | $446.68 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,168.69 / $12,022.64
| Facility | | $3,630.78 | $4,168.69 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $467.74 / $1,047.13
| Professional | | $186.21 | $467.74 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $4,677.35 / $5,128.61
| Facility | | $4,677.35 | $4,677.35 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $707.95 / $1,584.89
| Professional | | $263.03 | $707.95 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,513.56 / $1,949.84
| Professional | | $831.76 | $1,513.56 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $3,981.07 / $4,265.80
| Facility | | $3,801.89 | $3,981.07 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $6,025.60 / $9,332.54
| Facility | | $3,388.44 | $6,025.60 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $436.52 / $1,096.48
| Professional | | $165.96 | $436.52 | $1,096.48 |