- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $4,570.88 / $11,481.54
| Facility | | $1,288.25 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,288.25 / $2,884.03
| Professional | | $1,071.52 | $1,288.25 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $13,489.63 / $28,183.83
| Facility | | $4,677.35 | $13,489.63 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,621.81 / $3,090.30
| Professional | | $1,071.52 | $1,621.81 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,019.95 / $8,317.64
| Facility | | $398.11 | $3,019.95 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,905.46 / $4,168.69
| Professional | | $1,202.26 | $1,905.46 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,513.56 / $2,818.38
| Professional | | $1,047.13 | $1,513.56 | $2,818.38 |