- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $4,897.79 / $14,125.38
| Facility | | $1,380.38 | $4,897.79 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,479.11 / $2,238.72
| Professional | | $977.24 | $1,479.11 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $25,703.96 / $32,359.37
| Facility | | $9,772.37 | $25,703.96 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $912.01 / $3,890.45
| Professional | | $724.44 | $912.01 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $54,954.09 / $87,096.36
| Facility | | $3,630.78 | $54,954.09 | $87,096.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,122.02 / $1,122.02
| Professional | | $1,122.02 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $11,220.18 / $17,378.01
| Facility | | $5,128.61 | $11,220.18 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $1,096.48 / $3,019.95
| Professional | | $524.81 | $1,096.48 | $3,019.95 |