- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $5,248.07 / $12,302.69
| Facility | | $1,230.27 | $5,248.07 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $933.25 / $2,041.74
| Professional | | $794.33 | $933.25 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $8,511.38 / $16,218.10
| Facility | | $3,235.94 | $8,511.38 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,174.90 / $2,238.72
| Professional | | $831.76 | $1,174.90 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,162.28 / $7,762.47
| Facility | | $2,290.87 | $3,162.28 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,570.40 / $4,073.80
| Professional | | $1,445.44 | $2,570.40 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $8,709.64 / $19,054.61
| Facility | | $2,884.03 | $8,709.64 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,047.13 / $1,949.84
| Professional | | $741.31 | $1,047.13 | $1,949.84 |