- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $4,073.80 / $10,715.19
| Facility | | $870.96 | $4,073.80 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $1,071.52 / $2,454.71
| Professional | | $331.13 | $1,071.52 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $7,079.46 / $15,135.61
| Facility | | $2,398.83 | $7,079.46 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $1,258.93 / $2,951.21
| Professional | | $346.74 | $1,258.93 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $5,011.87 / $17,378.01
| Facility | | $562.34 | $5,011.87 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $1,174.90 / $3,630.78
| Professional | | $363.08 | $1,174.90 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,623.41 / $12,882.50
| Facility | | $1,995.26 | $5,623.41 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $1,122.02 / $2,691.53
| Professional | | $331.13 | $1,122.02 | $2,691.53 |