- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,370.32 / $14,454.40
| Facility | | $1,412.54 | $5,370.32 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $1,288.25 / $2,187.76
| Professional | | $338.84 | $1,288.25 | $2,187.76 |
- 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
- $371.54 / $1,230.27 / $2,398.83
| Professional | | $371.54 | $1,230.27 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $758.58 / $2,290.87
| Professional | | $398.11 | $758.58 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $1,995.26 / $2,884.03
| Professional | | $416.87 | $1,995.26 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $1,202.26 / $1,412.54
| Professional | | $295.12 | $1,202.26 | $1,412.54 |
- 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
- $407.38 / $1,258.93 / $2,511.89
| Professional | | $407.38 | $1,258.93 | $2,511.89 |