- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $6,025.60 / $15,135.61
| Facility | | $1,445.44 | $6,025.60 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $977.24 / $2,041.74
| Professional | | $524.81 | $977.24 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $11,220.18 / $23,988.33
| Facility | | $4,168.69 | $11,220.18 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,148.15 / $2,238.72
| Professional | | $724.44 | $1,148.15 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,754.23 / $12,022.64
| Facility | | $933.25 | $2,754.23 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,348.96 / $2,398.83
| Professional | | $588.84 | $1,348.96 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,244.36 / $17,378.01
| Facility | | $2,511.89 | $7,244.36 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,288.25 / $2,290.87
| Professional | | $812.83 | $1,288.25 | $2,290.87 |