- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $4,677.35 / $12,882.50
| Facility | | $1,318.26 | $4,677.35 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $2,344.23 / $3,019.95
| Professional | | $478.63 | $2,344.23 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,897.79 / $15,135.61
| Facility | | $2,041.74 | $4,897.79 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $239.88 / $3,311.31
| Professional | | $208.93 | $239.88 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $6,025.60 / $14,125.38
| Facility | | $2,041.74 | $6,025.60 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,570.88 / $9,332.54
| Professional | | $3,630.78 | $4,570.88 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,162.28 / $3,801.89
| Facility | | $1,905.46 | $3,162.28 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,905.46 / $3,801.89
| Professional | | $1,318.26 | $1,905.46 | $3,801.89 |