- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $4,677.35 / $11,748.98
| Facility | | $1,148.15 | $4,677.35 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,096.48 / $1,949.84
| Professional | | $912.01 | $1,096.48 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $14,125.38 / $33,113.11
| Facility | | $4,786.30 | $14,125.38 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,096.48 / $2,454.71
| Professional | | $758.58 | $1,096.48 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $2,818.38 / $7,762.47
| Facility | | $323.59 | $2,818.38 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,584.89 / $3,235.94
| Professional | | $1,000.00 | $1,584.89 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,348.96 / $2,398.83
| Professional | | $912.01 | $1,348.96 | $2,398.83 |