- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,495.41 / $12,302.69
| Facility | | $1,412.54 | $5,495.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,258.93 / $2,089.30
| Professional | | $831.76 | $1,258.93 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $7,079.46 / $20,417.38
| Facility | | $3,548.13 | $7,079.46 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,318.26 / $2,290.87
| Professional | | $912.01 | $1,318.26 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $3,981.07 / $11,220.18
| Facility | | $602.56 | $3,981.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,041.74 / $5,623.41
| Professional | | $1,122.02 | $2,041.74 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $8,511.38 / $19,054.61
| Facility | | $2,884.03 | $8,511.38 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,202.26 / $2,630.27
| Professional | | $707.95 | $1,202.26 | $2,630.27 |