- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $5,495.41 / $14,125.38
| Facility | | $1,230.27 | $5,495.41 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $831.76 / $1,819.70
| Professional | | $707.95 | $831.76 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $12,302.69 / $30,199.52
| Facility | | $4,466.84 | $12,302.69 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,023.29 / $1,949.84
| Professional | | $676.08 | $1,023.29 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $2,511.89 / $12,022.64
| Facility | | $724.44 | $2,511.89 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,174.90 / $2,454.71
| Professional | | $758.58 | $1,174.90 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,943.28 / $25,703.96
| Facility | | $2,454.71 | $7,943.28 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $912.01 / $1,737.80
| Professional | | $660.69 | $912.01 | $1,737.80 |