- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $7,079.46 / $19,952.62
| Facility | | $2,344.23 | $7,079.46 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,122.02 / $2,511.89
| Professional | | $912.01 | $1,122.02 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $16,982.44 / $19,952.62
| Facility | | $8,709.64 | $16,982.44 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,621.81 / $2,238.72
| Professional | | $954.99 | $1,621.81 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,905.46 / $3,630.78
| Professional | | $1,318.26 | $1,905.46 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,412.54 / $2,344.23
| Professional | | $1,412.54 | $1,412.54 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,165.95 / $15,135.61
| Facility | | $3,311.31 | $6,165.95 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,513.56 / $2,630.27
| Professional | | $1,023.29 | $1,513.56 | $2,630.27 |