- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,677.35 / $12,022.64
| Facility | | $1,230.27 | $4,677.35 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,174.90 / $2,454.71
| Professional | | $977.24 | $1,174.90 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $11,481.54 / $24,547.09
| Facility | | $4,168.69 | $11,481.54 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,412.54 / $2,691.53
| Professional | | $933.25 | $1,412.54 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,388.44 / $10,232.93
| Facility | | $398.11 | $3,388.44 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,819.70 / $3,890.45
| Professional | | $1,148.15 | $1,819.70 | $3,890.45 |
- 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
- $977.24 / $1,412.54 / $2,691.53
| Professional | | $977.24 | $1,412.54 | $2,691.53 |