- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $6,309.57 / $15,135.61
| Facility | | $1,318.26 | $6,309.57 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $630.96 / $1,230.27
| Professional | | $537.03 | $630.96 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $13,182.57 / $28,840.32
| Facility | | $4,570.88 | $13,182.57 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $660.69 / $1,479.11
| Professional | | $467.74 | $660.69 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,187.76 / $10,471.29
| Facility | | $645.65 | $2,187.76 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $954.99 / $2,089.30
| Professional | | $602.56 | $954.99 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $9,120.11 / $20,892.96
| Facility | | $2,951.21 | $9,120.11 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $794.33 / $1,445.44
| Professional | | $537.03 | $794.33 | $1,445.44 |