- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $4,786.30 / $11,748.98
| Facility | | $1,148.15 | $4,786.30 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $794.33 / $1,819.70
| Professional | | $676.08 | $794.33 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $8,912.51 / $18,620.87
| Facility | | $3,630.78 | $8,912.51 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $977.24 / $1,862.09
| Professional | | $660.69 | $977.24 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,754.23 / $12,302.69
| Facility | | $1,288.25 | $2,754.23 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,096.48 / $2,344.23
| Professional | | $741.31 | $1,096.48 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,709.64 / $19,054.61
| Facility | | $3,019.95 | $8,709.64 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $870.96 / $1,659.59
| Professional | | $630.96 | $870.96 | $1,659.59 |