- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $5,248.07 / $13,803.84
| Facility | | $1,047.13 | $5,248.07 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $2,238.72 / $11,481.54
| Professional | | $691.83 | $2,238.72 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $11,748.98 / $26,302.68
| Facility | | $4,466.84 | $11,748.98 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $5,754.40 / $14,125.38
| Professional | | $676.08 | $5,754.40 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $19,952.62 / $50,118.72
| Facility | | $398.11 | $19,952.62 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $3,019.95 / $16,982.44
| Professional | | $776.25 | $3,019.95 | $16,982.44 |
- 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
- $691.83 / $5,370.32 / $13,182.57
| Professional | | $691.83 | $5,370.32 | $13,182.57 |