- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $5,248.07 / $13,489.63
| Facility | | $1,380.38 | $5,248.07 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,659.59 / $3,162.28
| Professional | | $724.44 | $1,659.59 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $8,912.51 / $17,782.79
| Facility | | $3,467.37 | $8,912.51 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,288.25 / $2,754.23
| Professional | | $758.58 | $1,288.25 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $3,090.30 / $13,182.57
| Facility | | $1,202.26 | $3,090.30 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,905.46 / $4,466.84
| Professional | | $851.14 | $1,905.46 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,244.36 / $16,218.10
| Facility | | $2,454.71 | $7,244.36 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,621.81 / $3,467.37
| Professional | | $724.44 | $1,621.81 | $3,467.37 |