- 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
- $616.60 / $724.44 / $1,584.89
| Professional | | $616.60 | $724.44 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $6,918.31 / $15,848.93
| Facility | | $2,630.27 | $6,918.31 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $891.25 / $1,698.24
| Professional | | $616.60 | $891.25 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,862.09 / $5,623.41
| Facility | | $851.14 | $1,862.09 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,023.29 / $2,187.76
| Professional | | $676.08 | $1,023.29 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,754.40 / $14,125.38
| Facility | | $1,949.84 | $5,754.40 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $794.33 / $1,513.56
| Professional | | $575.44 | $794.33 | $1,513.56 |