- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,897.79 / $12,022.64
| Facility | | $1,023.29 | $4,897.79 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $1,445.44 / $2,951.21
| Professional | | $363.08 | $1,445.44 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $7,079.46 / $18,620.87
| Facility | | $3,162.28 | $7,079.46 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $1,621.81 / $3,715.35
| Professional | | $346.74 | $1,621.81 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $4,677.35 / $13,489.63
| Facility | | $380.19 | $4,677.35 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $1,412.54 / $4,466.84
| Professional | | $407.38 | $1,412.54 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $8,511.38 / $18,620.87
| Facility | | $2,951.21 | $8,511.38 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,513.56 / $3,548.13
| Professional | | $371.54 | $1,513.56 | $3,548.13 |