- 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
- $575.44 / $660.69 / $1,479.11
| Professional | | $575.44 | $660.69 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $7,762.47 / $15,488.17
| Facility | | $3,162.28 | $7,762.47 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $794.33 / $1,548.82
| Professional | | $562.34 | $794.33 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,995.26 / $10,232.93
| Facility | | $660.69 | $1,995.26 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $933.25 / $1,995.26
| Professional | | $602.56 | $933.25 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,623.41 / $12,302.69
| Facility | | $1,949.84 | $5,623.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $724.44 / $1,380.38
| Professional | | $524.81 | $724.44 | $1,380.38 |