- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $7,079.46 / $16,595.87
| Facility | | $2,041.74 | $7,079.46 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,348.96 / $1,949.84
| Professional | | $933.25 | $1,348.96 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $9,120.11 / $20,417.38
| Facility | | $4,570.88 | $9,120.11 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,202.26 / $2,951.21
| Professional | | $851.14 | $1,202.26 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $10,232.93 / $18,620.87
| Facility | | $3,981.07 | $10,232.93 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $1,949.84 / $2,454.71
| Professional | | $331.13 | $1,949.84 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $8,511.38 / $18,620.87
| Facility | | $2,951.21 | $8,511.38 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,862.09 / $3,388.44
| Professional | | $1,230.27 | $1,862.09 | $3,388.44 |