- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,570.88 / $11,481.54
| Facility | | $1,023.29 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $891.25 / $1,862.09
| Professional | | $724.44 | $891.25 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $12,022.64 / $22,387.21
| Facility | | $4,365.16 | $12,022.64 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,148.15 / $2,089.30
| Professional | | $812.83 | $1,148.15 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,041.74 / $6,165.95
| Facility | | $398.11 | $2,041.74 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,318.26 / $2,818.38
| Professional | | $851.14 | $1,318.26 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,235.94 / $10,471.29
| Facility | | $851.14 | $3,235.94 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,096.48 / $1,995.26
| Professional | | $776.25 | $1,096.48 | $1,995.26 |