- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,677.35 / $12,022.64
| Facility | | $1,023.29 | $4,677.35 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $977.24 / $1,949.84
| Professional | | $794.33 | $977.24 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $6,456.54 / $12,589.25
| Facility | | $2,041.74 | $6,456.54 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,148.15 / $2,290.87
| Professional | | $741.31 | $1,148.15 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,187.76 / $6,456.54
| Facility | | $398.11 | $2,187.76 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,380.38 / $2,691.53
| Professional | | $870.96 | $1,380.38 | $2,691.53 |
- 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
- $776.25 / $1,202.26 / $2,041.74
| Professional | | $776.25 | $1,202.26 | $2,041.74 |