- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $4,570.88 / $10,964.78
| Facility | | $1,096.48 | $4,570.88 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $416.87 / $1,071.52
| Professional | | $354.81 | $416.87 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $7,943.28 / $16,982.44
| Facility | | $2,754.23 | $7,943.28 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $389.05 / $831.76
| Professional | | $302.00 | $389.05 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,318.26 / $7,413.10
| Facility | | $691.83 | $1,318.26 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $758.58 / $1,584.89
| Professional | | $331.13 | $758.58 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,786.30 / $11,748.98
| Facility | | $1,513.56 | $4,786.30 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $501.19 / $891.25
| Professional | | $338.84 | $501.19 | $891.25 |