- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $4,897.79 / $11,748.98
| Facility | | $1,202.26 | $4,897.79 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,122.02 / $2,454.71
| Professional | | $371.54 | $1,122.02 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $9,772.37 / $19,498.45
| Facility | | $2,238.72 | $9,772.37 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $870.96 / $2,884.03
| Professional | | $478.63 | $870.96 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $16,982.44 / $46,773.51
| Facility | | $1,862.09 | $16,982.44 | $46,773.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,011.87 / $6,025.60 / $7,413.10
| Professional | | $5,011.87 | $6,025.60 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,162.28 / $10,232.93
| Facility | | $812.83 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,548.82 / $5,128.61
| Professional | | $1,047.13 | $1,548.82 | $5,128.61 |