- 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
- $741.31 / $912.01 / $1,659.59
| Professional | | $741.31 | $912.01 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $11,481.54 / $26,302.68
| Facility | | $3,311.31 | $11,481.54 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,047.13 / $2,089.30
| Professional | | $707.95 | $1,047.13 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,041.74 / $6,025.60
| Facility | | $398.11 | $2,041.74 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,258.93 / $2,511.89
| Professional | | $812.83 | $1,258.93 | $2,511.89 |
- 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
- $724.44 / $1,071.52 / $1,905.46
| Professional | | $724.44 | $1,071.52 | $1,905.46 |