- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $5,011.87 / $12,022.64
| Facility | | $1,380.38 | $5,011.87 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,047.13 / $2,344.23
| Professional | | $912.01 | $1,047.13 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $7,079.46 / $16,595.87
| Facility | | $3,311.31 | $7,079.46 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,348.96 / $2,511.89
| Professional | | $933.25 | $1,348.96 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,951.21 / $8,511.38
| Facility | | $1,122.02 | $2,951.21 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,548.82 / $3,311.31
| Professional | | $977.24 | $1,548.82 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,709.64 / $18,620.87
| Facility | | $3,019.95 | $8,709.64 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,258.93 / $2,344.23
| Professional | | $891.25 | $1,258.93 | $2,344.23 |