- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,754.40 / $14,125.38
| Facility | | $1,412.54 | $5,754.40 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,023.29 / $2,344.23
| Professional | | $851.14 | $1,023.29 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $10,715.19 / $20,417.38
| Facility | | $3,981.07 | $10,715.19 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,318.26 / $2,398.83
| Professional | | $870.96 | $1,318.26 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,454.71 / $7,079.46
| Facility | | $398.11 | $2,454.71 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,479.11 / $3,235.94
| Professional | | $933.25 | $1,479.11 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $7,943.28 / $17,782.79
| Facility | | $2,951.21 | $7,943.28 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,202.26 / $2,187.76
| Professional | | $851.14 | $1,202.26 | $2,187.76 |