- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $4,897.79 / $11,481.54
| Facility | | $1,412.54 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,122.02 / $2,691.53
| Professional | | $954.99 | $1,122.02 | $2,691.53 |
- 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
- $977.24 / $1,412.54 / $2,630.27
| Professional | | $977.24 | $1,412.54 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $2,754.23 / $7,585.78
| Facility | | $323.59 | $2,754.23 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,584.89 / $3,388.44
| Professional | | $1,047.13 | $1,584.89 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $8,709.64 / $20,892.96
| Facility | | $2,511.89 | $8,709.64 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,288.25 / $2,344.23
| Professional | | $891.25 | $1,288.25 | $2,344.23 |