- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $4,365.16 / $10,964.78
| Facility | | $1,202.26 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,047.13 / $2,454.71
| Professional | | $891.25 | $1,047.13 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $8,511.38 / $20,417.38
| Facility | | $3,162.28 | $8,511.38 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,288.25 / $2,454.71
| Professional | | $851.14 | $1,288.25 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,630.27 / $7,413.10
| Facility | | $1,122.02 | $2,630.27 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,445.44 / $3,090.30
| Professional | | $977.24 | $1,445.44 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,754.40 / $14,125.38
| Facility | | $1,949.84 | $5,754.40 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,174.90 / $2,137.96
| Professional | | $812.83 | $1,174.90 | $2,137.96 |