- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $5,248.07 / $12,302.69
| Facility | | $1,122.02 | $5,248.07 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $676.08 / $1,380.38
| Professional | | $575.44 | $676.08 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $11,220.18 / $26,302.68
| Facility | | $3,715.35 | $11,220.18 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $831.76 / $1,584.89
| Professional | | $575.44 | $831.76 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,905.46 / $9,120.11
| Facility | | $912.01 | $1,905.46 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $933.25 / $2,041.74
| Professional | | $630.96 | $933.25 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,585.78 / $18,197.01
| Facility | | $2,454.71 | $7,585.78 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $758.58 / $1,412.54
| Professional | | $537.03 | $758.58 | $1,412.54 |