- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $5,495.41 / $14,125.38
| Facility | | $1,548.82 | $5,495.41 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $1,122.02 / $1,949.84
| Professional | | $302.00 | $1,122.02 | $1,949.84 |
- 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
- $338.84 / $1,096.48 / $2,187.76
| Professional | | $338.84 | $1,096.48 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $707.95 / $2,089.30
| Professional | | $354.81 | $707.95 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $2,238.72 / $2,754.23
| Professional | | $416.87 | $2,238.72 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $1,318.26 / $1,584.89
| Professional | | $295.12 | $1,318.26 | $1,584.89 |
- 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
- $363.08 / $1,122.02 / $2,187.76
| Professional | | $363.08 | $1,122.02 | $2,187.76 |