- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $4,897.79 / $16,218.10
| Facility | | $1,380.38 | $4,897.79 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,202.26 / $1,737.80
| Professional | | $776.25 | $1,202.26 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $28,183.83 / $41,686.94
| Facility | | $5,623.41 | $28,183.83 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $912.01 / $1,479.11
| Professional | | $776.25 | $912.01 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,412.54 / $1,584.89
| Facility | | $1,258.93 | $1,412.54 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,698.24 / $4,677.35
| Facility | | $1,202.26 | $1,698.24 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,445.44 / $2,089.30
| Professional | | $1,023.29 | $1,445.44 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $11,220.18 / $17,378.01
| Facility | | $5,011.87 | $11,220.18 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $977.24 / $1,737.80
| Professional | | $676.08 | $977.24 | $1,737.80 |