- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,677.35 / $11,481.54
| Facility | | $1,023.29 | $4,677.35 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $616.60 / $1,318.26
| Professional | | $467.74 | $616.60 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $7,413.10 / $15,135.61
| Facility | | $2,884.03 | $7,413.10 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $758.58 / $1,380.38
| Professional | | $489.78 | $758.58 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,862.09 / $11,481.54
| Facility | | $691.83 | $1,862.09 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $851.14 / $1,698.24
| Professional | | $524.81 | $851.14 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,888.44 / $14,125.38
| Facility | | $1,995.26 | $5,888.44 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $691.83 / $1,230.27
| Professional | | $457.09 | $691.83 | $1,230.27 |