- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $5,128.61 / $12,882.50
| Facility | | $1,148.15 | $5,128.61 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $645.65 / $1,023.29
| Professional | | $407.38 | $645.65 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $9,120.11 / $24,547.09
| Facility | | $3,801.89 | $9,120.11 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $707.95 / $1,548.82
| Professional | | $245.47 | $707.95 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,000.00 / $10,964.78
| Facility | | $398.11 | $1,000.00 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $912.01 / $3,235.94
| Professional | | $524.81 | $912.01 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $10,471.29 / $25,703.96
| Facility | | $3,162.28 | $10,471.29 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $707.95 / $1,698.24
| Professional | | $363.08 | $707.95 | $1,698.24 |