- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $5,370.32 / $7,413.10
| Facility | | $1,023.29 | $5,370.32 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $851.14 / $1,584.89
| Professional | | $346.74 | $851.14 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,818.38 / $6,025.60
| Facility | | $1,174.90 | $2,818.38 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $1,047.13 / $1,905.46
| Professional | | $436.52 | $1,047.13 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $10,471.29 / $11,748.98
| Facility | | $7,244.36 | $10,471.29 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $1,023.29 / $2,187.76
| Professional | | $457.09 | $1,023.29 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $977.24 / $3,019.95
| Professional | | $371.54 | $977.24 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $776.25 / $1,737.80
| Professional | | $346.74 | $776.25 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $5,888.44 / $9,120.11
| Facility | | $1,513.56 | $5,888.44 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $912.01 / $1,995.26
| Professional | | $380.19 | $912.01 | $1,995.26 |