- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,981.07 / $6,456.54
| Facility | | $1,071.52 | $3,981.07 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $524.81 / $1,122.02
| Professional | | $380.19 | $524.81 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $1,659.59 / $5,128.61
| Professional | | $407.38 | $1,659.59 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $616.60 / $1,174.90
| Professional | | $426.58 | $616.60 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $851.14 / $977.24
| Professional | | $426.58 | $851.14 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $12,022.64 / $26,302.68
| Facility | | $2,344.23 | $12,022.64 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $562.34 / $1,174.90
| Professional | | $363.08 | $562.34 | $1,174.90 |