- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $5,370.32 / $12,589.25
| Facility | | $1,318.26 | $5,370.32 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,096.48 / $2,818.38
| Professional | | $933.25 | $1,096.48 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $8,709.64 / $16,982.44
| Facility | | $3,090.30 | $8,709.64 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,174.90 / $2,344.23
| Professional | | $707.95 | $1,174.90 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,691.53 / $7,413.10
| Facility | | $1,621.81 | $2,691.53 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,445.44 / $3,235.94
| Professional | | $912.01 | $1,445.44 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,951.21 / $6,918.31
| Facility | | $1,000.00 | $2,951.21 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,174.90 / $2,238.72
| Professional | | $812.83 | $1,174.90 | $2,238.72 |