- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $4,466.84 / $10,964.78
| Facility | | $1,047.13 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $758.58 / $1,698.24
| Professional | | $645.65 | $758.58 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $7,413.10 / $15,135.61
| Facility | | $2,951.21 | $7,413.10 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $933.25 / $1,778.28
| Professional | | $660.69 | $933.25 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,621.81 / $5,370.32
| Facility | | $676.08 | $1,621.81 | $5,370.32 |
- 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
- $2,398.83 / $6,918.31 / $15,488.17
| Facility | | $2,398.83 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $831.76 / $1,584.89
| Professional | | $602.56 | $831.76 | $1,584.89 |