- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $4,677.35 / $11,481.54
| Facility | | $1,071.52 | $4,677.35 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $1,862.09 / $3,890.45
| Professional | | $426.58 | $1,862.09 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,456.54 / $14,125.38
| Facility | | $2,290.87 | $6,456.54 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $851.14 / $3,890.45
| Professional | | $389.05 | $851.14 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $3,388.44 / $16,218.10
| Facility | | $446.68 | $3,388.44 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $1,862.09 / $5,370.32
| Professional | | $426.58 | $1,862.09 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $6,918.31 / $15,488.17
| Facility | | $2,238.72 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $1,698.24 / $3,801.89
| Professional | | $389.05 | $1,698.24 | $3,801.89 |