- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $6,165.95 / $14,454.40
| Facility | | $1,318.26 | $6,165.95 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $3,630.78 / $9,549.93
| Professional | | $758.58 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $12,589.25 / $28,840.32
| Facility | | $4,570.88 | $12,589.25 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $4,677.35 / $11,481.54
| Professional | | $912.01 | $4,677.35 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $16,595.87 / $43,651.58
| Facility | | $1,318.26 | $16,595.87 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $2,691.53 / $14,791.08
| Professional | | $851.14 | $2,691.53 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $11,220.18 / $28,183.83
| Facility | | $3,715.35 | $11,220.18 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,905.46 / $11,481.54
| Professional | | $758.58 | $1,905.46 | $11,481.54 |