- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $7,413.10 / $16,595.87
| Facility | | $2,238.72 | $7,413.10 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $288.40 / $1,000.00
| Professional | | $239.88 | $288.40 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $10,964.78 / $20,892.96
| Facility | | $4,168.69 | $10,964.78 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $1,258.93 / $3,981.07
| Professional | | $338.84 | $1,258.93 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $10,471.29 / $22,908.68
| Facility | | $1,023.29 | $10,471.29 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $758.58 / $1,230.27
| Professional | | $524.81 | $758.58 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $7,244.36 / $15,488.17
| Facility | | $2,398.83 | $7,244.36 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $363.08 / $645.65
| Professional | | $251.19 | $363.08 | $645.65 |