- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $5,754.40 / $14,125.38
| Facility | | $1,288.25 | $5,754.40 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $954.99 / $2,344.23
| Professional | | $741.31 | $954.99 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $11,481.54 / $26,915.35
| Facility | | $4,677.35 | $11,481.54 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,174.90 / $2,290.87
| Professional | | $776.25 | $1,174.90 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $3,090.30 / $18,620.87
| Facility | | $1,148.15 | $3,090.30 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,348.96 / $2,754.23
| Professional | | $831.76 | $1,348.96 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $9,120.11 / $20,417.38
| Facility | | $3,019.95 | $9,120.11 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,122.02 / $1,949.84
| Professional | | $758.58 | $1,122.02 | $1,949.84 |