- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $4,570.88 / $11,481.54
| Facility | | $1,047.13 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $912.01 / $2,137.96
| Professional | | $758.58 | $912.01 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,585.78 / $15,848.93
| Facility | | $2,818.38 | $7,585.78 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,122.02 / $2,137.96
| Professional | | $741.31 | $1,122.02 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,089.30 / $5,888.44
| Facility | | $398.11 | $2,089.30 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,348.96 / $2,884.03
| Professional | | $831.76 | $1,348.96 | $2,884.03 |
- 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
- $758.58 / $1,071.52 / $2,041.74
| Professional | | $758.58 | $1,071.52 | $2,041.74 |