- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $7,079.46 / $11,748.98
| Facility | | $1,258.93 | $7,079.46 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $758.58 / $1,445.44
| Professional | | $275.42 | $758.58 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $16,982.44 / $19,952.62
| Facility | | $8,709.64 | $16,982.44 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $776.25 / $1,949.84
| Professional | | $371.54 | $776.25 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $1,096.48 / $2,951.21
| Professional | | $489.78 | $1,096.48 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,548.82 / $1,698.24
| Professional | | $1,548.82 | $1,548.82 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $11,220.18 / $18,620.87
| Facility | | $7,244.36 | $11,220.18 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $831.76 / $2,137.96
| Professional | | $316.23 | $831.76 | $2,137.96 |