- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $4,786.30 / $13,803.84
| Facility | | $1,047.13 | $4,786.30 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $954.99 / $1,949.84
| Professional | | $776.25 | $954.99 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,918.31 / $23,988.33
| Facility | | $3,311.31 | $6,918.31 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,174.90 / $2,290.87
| Professional | | $758.58 | $1,174.90 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $5,495.41 / $30,902.95
| Facility | | $1,380.38 | $5,495.41 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,318.26 / $2,691.53
| Professional | | $812.83 | $1,318.26 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,235.94 / $10,471.29
| Facility | | $851.14 | $3,235.94 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,071.52 / $1,949.84
| Professional | | $741.31 | $1,071.52 | $1,949.84 |