- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,630.27 / $6,760.83
| Facility | | $1,047.13 | $2,630.27 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $831.76 / $1,548.82
| Professional | | $275.42 | $831.76 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $6,606.93 / $10,715.19
| Facility | | $4,168.69 | $6,606.93 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $467.74 / $1,819.70
| Professional | | $316.23 | $467.74 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,949.84 / $7,244.36
| Facility | | $380.19 | $1,949.84 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,318.26 / $8,709.64
| Professional | | $933.25 | $1,318.26 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,265.80 / $8,128.31
| Facility | | $1,230.27 | $4,265.80 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $831.76 / $1,445.44
| Professional | | $245.47 | $831.76 | $1,445.44 |