- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $5,128.61 / $12,022.64
| Facility | | $1,148.15 | $5,128.61 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $758.58 / $1,659.59
| Professional | | $630.96 | $758.58 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $9,772.37 / $17,782.79
| Facility | | $3,388.44 | $9,772.37 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $933.25 / $1,778.28
| Professional | | $645.65 | $933.25 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,584.89 / $5,248.07
| Facility | | $398.11 | $1,584.89 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,047.13 / $2,290.87
| Professional | | $691.83 | $1,047.13 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,079.46 / $16,218.10
| Facility | | $2,454.71 | $7,079.46 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $851.14 / $1,621.81
| Professional | | $602.56 | $851.14 | $1,621.81 |