- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,623.41 / $11,220.18
| Facility | | $1,862.09 | $5,623.41 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $1,258.93 / $2,511.89
| Professional | | $346.74 | $1,258.93 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $9,549.93 / $17,378.01
| Facility | | $4,786.30 | $9,549.93 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $1,288.25 / $2,818.38
| Professional | | $398.11 | $1,288.25 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $831.76 / $2,630.27
| Professional | | $389.05 | $831.76 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $2,344.23 / $2,818.38
| Professional | | $446.68 | $2,344.23 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $1,380.38 / $1,659.59
| Professional | | $316.23 | $1,380.38 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $8,511.38 / $16,595.87
| Facility | | $3,548.13 | $8,511.38 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $1,202.26 / $2,884.03
| Professional | | $416.87 | $1,202.26 | $2,884.03 |