- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $4,365.16 / $10,964.78
| Facility | | $1,096.48 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $776.25 / $1,659.59
| Professional | | $660.69 | $776.25 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $8,511.38 / $23,442.29
| Facility | | $3,162.28 | $8,511.38 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,071.52 / $1,905.46
| Professional | | $691.83 | $1,071.52 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,238.72 / $8,709.64
| Facility | | $1,258.93 | $2,238.72 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,148.15 / $2,290.87
| Professional | | $741.31 | $1,148.15 | $2,290.87 |
- 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
- $630.96 / $912.01 / $1,659.59
| Professional | | $630.96 | $912.01 | $1,659.59 |