- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,226.08 / $5,767.84 / $8,457.70
| Facility | | $3,226.08 | $5,767.84 | $8,457.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.97 / $531.66 / $2,068.34
| Professional | | $202.97 | $531.66 | $2,068.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $236.44 / $319.19 / $390.13
| Facility | | $236.44 | $319.19 | $390.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.73 / $3,888.54 / $4,128.25
| Professional | | $283.73 | $3,888.54 | $4,128.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $418.47 / $418.47 / $418.47
| Facility | | $418.47 | $418.47 | $418.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.73 / $1,541.72 / $4,156.35
| Professional | | $283.73 | $1,541.72 | $4,156.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,431.29 / $10,429.42 / $25,136.07
| Facility | | $2,431.29 | $10,429.42 | $25,136.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,139.18 / $1,927.85 / $3,596.13
| Professional | | $1,139.18 | $1,927.85 | $3,596.13 |