- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $4,677.35 / $11,481.54
| Facility | | $1,047.13 | $4,677.35 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $602.56 / $1,348.96
| Professional | | $489.78 | $602.56 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $5,754.40 / $12,882.50
| Facility | | $2,344.23 | $5,754.40 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $707.95 / $1,348.96
| Professional | | $489.78 | $707.95 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,862.09 / $11,748.98
| Facility | | $977.24 | $1,862.09 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $831.76 / $1,819.70
| Professional | | $549.54 | $831.76 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $5,248.07 / $12,022.64
| Facility | | $1,548.82 | $5,248.07 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $660.69 / $1,230.27
| Professional | | $467.74 | $660.69 | $1,230.27 |