- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $6,025.60 / $13,803.84
| Facility | | $1,548.82 | $6,025.60 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,071.52 / $1,348.96
| Professional | | $741.31 | $1,071.52 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $15,848.93 / $31,622.78
| Facility | | $5,888.44 | $15,848.93 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $1,122.02 / $2,089.30
| Professional | | $295.12 | $1,122.02 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $10,715.19 / $19,498.45
| Facility | | $3,388.44 | $10,715.19 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $5,248.07 / $5,248.07
| Professional | | $1,737.80 | $5,248.07 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $12,022.64 / $28,840.32
| Facility | | $3,630.78 | $12,022.64 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,513.56 / $2,691.53
| Professional | | $1,047.13 | $1,513.56 | $2,691.53 |