- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $4,897.79 / $8,511.38
| Facility | | $2,691.53 | $4,897.79 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $549.54 / $1,548.82
| Professional | | $426.58 | $549.54 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,365.16 / $10,964.78
| Facility | | $3,715.35 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $870.96 / $1,230.27
| Professional | | $446.68 | $870.96 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $741.31
| Facility | | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $851.14 / $1,412.54
| Professional | | $575.44 | $851.14 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $660.69 / $1,174.90
| Professional | | $524.81 | $660.69 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,079.46 / $11,220.18
| Facility | | $4,570.88 | $7,079.46 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $676.08 / $1,479.11
| Professional | | $389.05 | $676.08 | $1,479.11 |