- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $5,623.41 / $16,218.10
| Facility | | $1,071.52 | $5,623.41 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $1,659.59 / $3,715.35
| Professional | | $436.52 | $1,659.59 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $11,481.54 / $26,302.68
| Facility | | $3,801.89 | $11,481.54 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $2,089.30 / $4,786.30
| Professional | | $436.52 | $2,089.30 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $7,079.46 / $20,417.38
| Facility | | $501.19 | $7,079.46 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $1,737.80 / $5,754.40
| Professional | | $489.78 | $1,737.80 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $10,964.78 / $26,915.35
| Facility | | $3,630.78 | $10,964.78 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $1,905.46 / $4,570.88
| Professional | | $457.09 | $1,905.46 | $4,570.88 |