- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $5,754.40 / $12,302.69
| Facility | | $1,047.13 | $5,754.40 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $812.83 / $4,073.80
| Professional | | $239.88 | $812.83 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $9,120.11 / $18,197.01
| Facility | | $3,630.78 | $9,120.11 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $1,698.24 / $4,073.80
| Professional | | $316.23 | $1,698.24 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $7,079.46 / $19,054.61
| Facility | | $416.87 | $7,079.46 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $1,479.11 / $4,786.30
| Professional | | $302.00 | $1,479.11 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,754.40 / $13,182.57
| Facility | | $2,041.74 | $5,754.40 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $1,318.26 / $3,467.37
| Professional | | $269.15 | $1,318.26 | $3,467.37 |