- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,897.79 / $11,481.54
| Facility | | $1,023.29 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $630.96 / $1,174.90
| Professional | | $501.19 | $630.96 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $7,585.78 / $14,791.08
| Facility | | $2,630.27 | $7,585.78 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $676.08 / $1,230.27
| Professional | | $467.74 | $676.08 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,380.38 / $3,019.95
| Facility | | $660.69 | $1,380.38 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $741.31 / $1,659.59
| Professional | | $478.63 | $741.31 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,981.07 / $9,549.93
| Facility | | $1,047.13 | $3,981.07 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $630.96 / $1,148.15
| Professional | | $457.09 | $630.96 | $1,148.15 |