- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $6,456.54 / $15,135.61
| Facility | | $1,202.26 | $6,456.54 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $2,818.38 / $9,120.11
| Professional | | $501.19 | $2,818.38 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $9,332.54 / $28,840.32
| Facility | | $4,570.88 | $9,332.54 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $5,623.41 / $13,182.57
| Professional | | $512.86 | $5,623.41 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $17,378.01 / $40,738.03
| Facility | | $851.14 | $17,378.01 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $2,398.83 / $14,791.08
| Professional | | $575.44 | $2,398.83 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $16,218.10 / $41,686.94
| Facility | | $4,897.79 | $16,218.10 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $5,011.87 / $12,302.69
| Professional | | $524.81 | $5,011.87 | $12,302.69 |