- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $5,128.61 / $12,022.64
| Facility | | $1,023.29 | $5,128.61 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $602.56 / $1,230.27
| Professional | | $467.74 | $602.56 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $8,709.64 / $16,982.44
| Facility | | $3,090.30 | $8,709.64 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $645.65 / $1,230.27
| Professional | | $426.58 | $645.65 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,737.80 / $3,801.89
| Facility | | $831.76 | $1,737.80 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $724.44 / $1,698.24
| Professional | | $436.52 | $724.44 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,495.41 / $12,589.25
| Facility | | $1,819.70 | $5,495.41 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $562.34 / $1,047.13
| Professional | | $416.87 | $562.34 | $1,047.13 |