- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $5,248.07 / $12,022.64
| Facility | | $1,288.25 | $5,248.07 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,148.15 / $2,511.89
| Professional | | $851.14 | $1,148.15 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,128.61 / $13,803.84
| Facility | | $2,570.40 | $5,128.61 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,230.27 / $2,290.87
| Professional | | $851.14 | $1,230.27 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,884.03 / $7,413.10
| Facility | | $1,479.11 | $2,884.03 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,445.44 / $3,311.31
| Professional | | $891.25 | $1,445.44 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,244.36 / $16,218.10
| Facility | | $2,511.89 | $7,244.36 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,148.15 / $2,187.76
| Professional | | $812.83 | $1,148.15 | $2,187.76 |