- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,495.41 / $10,715.19
| Facility | | $2,089.30 | $5,495.41 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $512.86 / $1,202.26
| Professional | | $457.09 | $512.86 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $9,549.93 / $17,378.01
| Facility | | $4,570.88 | $9,549.93 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $741.31 / $1,148.15
| Professional | | $549.54 | $741.31 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $2,238.72 / $7,079.46
| Facility | | $851.14 | $2,238.72 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $676.08 / $1,096.48
| Professional | | $512.86 | $676.08 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $707.95 / $2,454.71
| Professional | | $501.19 | $707.95 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $933.25
| Professional | | $501.19 | $501.19 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $8,317.64 / $15,848.93
| Facility | | $3,548.13 | $8,317.64 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $660.69 / $1,230.27
| Professional | | $489.78 | $660.69 | $1,230.27 |