- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,511.89 / $11,220.18
| Facility | | $501.19 | $2,511.89 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $1,380.38 / $2,290.87
| Professional | | $426.58 | $1,380.38 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $19,054.61 / $28,183.83
| Facility | | $7,413.10 | $19,054.61 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $1,258.93 / $3,801.89
| Professional | | $478.63 | $1,258.93 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $457.09 / $512.86
| Facility | | $436.52 | $457.09 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $1,819.70 / $3,715.35
| Facility | | $446.68 | $1,819.70 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $1,862.09 / $3,162.28
| Professional | | $478.63 | $1,862.09 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $9,549.93 / $16,218.10
| Facility | | $4,168.69 | $9,549.93 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $1,445.44 / $2,884.03
| Professional | | $426.58 | $1,445.44 | $2,884.03 |