- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $5,623.41 / $15,488.17
| Facility | | $1,047.13 | $5,623.41 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $1,584.89 / $3,162.28
| Professional | | $346.74 | $1,584.89 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $10,471.29 / $20,892.96
| Facility | | $3,548.13 | $10,471.29 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $1,819.70 / $4,168.69
| Professional | | $363.08 | $1,819.70 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $5,888.44 / $16,218.10
| Facility | | $588.84 | $5,888.44 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $1,348.96 / $4,897.79
| Professional | | $407.38 | $1,348.96 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $8,709.64 / $18,620.87
| Facility | | $2,951.21 | $8,709.64 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $1,621.81 / $3,981.07
| Professional | | $363.08 | $1,621.81 | $3,981.07 |