- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,495.41 / $10,715.19
| Facility | | $2,089.30 | $5,495.41 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $645.65 / $1,412.54
| Professional | | $537.03 | $645.65 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $18,197.01 / $33,113.11
| Facility | | $11,481.54 | $18,197.01 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $776.25 / $1,071.52
| Professional | | $602.56 | $776.25 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $812.83 / $1,096.48
| Professional | | $630.96 | $812.83 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $660.69 / $2,187.76
| Professional | | $645.65 | $660.69 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $457.09 / $549.54
| Professional | | $457.09 | $457.09 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $8,128.31 / $16,595.87
| Facility | | $3,548.13 | $8,128.31 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $812.83 / $1,348.96
| Professional | | $630.96 | $812.83 | $1,348.96 |